presented in collaboration with nebraska icap, …...2020/06/16 · presented in collaboration with...
TRANSCRIPT
Presented in collaboration with Nebraska ICAP Nebraska DHHS HAI Team Nebraska Medicine and
The University of Nebraska Medical Center
Moderated by Mounica Soma
PanelistsDr Salman AshrafKate Tyner RN BSN CICMargaret Drake MT(ASCP)CICTeri Fitzgerald RN BSN CICDr Ishrat Kamal-Ahmed
Guest PanelistAlisha Dorn BSN RN CIC Nebraska Medicine
Guidance and responses were provided based on information known on 6162020 and may become out of date Guidance is
being updated rapidly so users should look to CDC and jurisdictional guidance for updates
Basic CDC Guidance on Re-openingStill HoldsBefore expanding to provide elective services healthcare systems must operate without crisis standards of care
bull Ensure adequate
bull HCP staffing
bull bed capacity
bull availability of personal protective equipment and other supplies
httpswwwcdcgovcoronavirus2019-ncovhcpframework-non-COVID-carehtml
Importance of local COVID-19 transmission data bull Substantial community transmission Large-scale community
transmission including within communal settings (eg schools workplaces)
bull Minimal to moderate community transmission Sustained transmission with high likelihood or confirmed exposure within communal settings and potential for rapid increase in cases
bull No to minimal community transmission Evidence of isolated cases or limited community transmission case investigations underway no evidence of exposure in large communal setting
From broad guidance to the local level
bull Joint Statement Roadmap for Resuming Elective Surgery after COVID-19 Pandemic
ldquoFacilities should use available testing to protect staff and patient safety whenever possible and should implement a policy addressing requirements and frequency for patient and staff testingrdquo
httpswwwaornorgguidelinesaorn-supportroadmap-for-resuming-elective-surgery-after-covid-19
Non-operative and Ambulatory Pre-Procedure Testing for COVID-19 Testing is not mandatory for procedures in which the risk of airway compromise is considered low (local anesthetic mild sedation or select moderate sedation cases) IF
bull Patients who are asymptomatic and can wear a procedure mask at all times
bull Patients who are asymptomatic and mask cannot be worn for a short period (lt15 minutes) during the procedure but all staff wear procedure masks
httpswwwnebraskamedcomsitesdefaultfilesdocumentscovid-19procedural-guidance-for-low-risk-procedures05112020pdf
Non-operative and Ambulatory Pre-Procedure Testing for COVID-19
Non-operative and Ambulatory Pre-Procedure Testing Guidancebull High-risk aerosol-generating procedures(AGPs) are defined within the
perioperative guidance and includebull surgery anywhere within the upper respiratory tract
bull flexible bronchoscopy
bull Rhinoscopy
bull laryngoscopy (including intubation)
bull GI endoscopy procedures with need for sedation or spinal anesthetic that have a high likelihood of requiring manual (bag valve mask) ventilation or intubation ( such as TEE ECT cardioversion C-section)
bull ENTOMFSDental procedures utilizing cautery laser drill or saw within the airway or oral cavity
httpswwwnebraskamedcomsitesdefaultfilesdocumentscovid-19procedural-guidance-for-low-risk-procedures05112020pdf
When COVID-19 Testing for patients shouldbe donebull COVID19 pre-procedural testing is mandatory for elective procedures
requiring deep sedationanalgesia and anesthesia
bull Patient has any symptoms concerning for COVID19 Symptomatic patients must be evaluated and procedures should be deferred until acute illness has resolved (per other guidance) If COVID19+ will need to defer procedure if possible If urgent COVID19 level precautions should be taken
bull In cases where Infection Control has approved specific guidance unique to a specialty such as Dentistry Interventional Radiology ECT
httpswwwnebraskamedcomsitesdefaultfilesdocumentscovid-19procedural-guidance-for-low-risk-procedures05112020pdf
Perioperative Testing Guidance
bull Complex and multi-factorial
bull Advise looking at all of the resources
httpswwwnebraskamedcomfor-providerscovid19operating-room-procedures
-
httpswwwnebraskamedcomsitesdefaultfilesdocumentscovid-19preprocedural-testing-algorithm-for-covid-positive-patientspdf
Pre-procedure testing
AORN httpswwwaornorgguidelinesaorn-supportroadmap-for-resuming-elective-surgery-after-covid-19
Facilities should use available testing to protect staff and patient safety whenever possible
CHI httpswwwchihealthcomenpatients-visitorscoronavirus-covid-19covid-19-elective-surgery-precautionshtml
ldquoRequiring COVID-19 testing for patients prior to certain procedures to provide appropriate care and to reduce the risk of infection for caregiversrdquo
Frequently Asked Questions
Should we see nursing home patients in our clinics Arenrsquot they really high risk for bringing COVID-19 into the facility
Image Pixabay
Yes
bull Long-term care facilities have had stringent infection control processes since March
bull Recommend use of a procedure mask for the residentbull Plus procedure mask for HCW for non-COVID-19 visits
bull Plus N95 respirator gown gloves eye protection for COVID-19 visits
Is there a tool to help me plan for or quantify a potential surge in COVID-19 cases
Image Pixabay
Yes
Here is a CDC tool for calculating a surge in your community
httpswwwcdcgovcoronavirus2019-ncovhcpCOVIDSurgehtml [cdcgov]
It has been a month since our resident was tested positive and he is
still testing positive although asymptomatic for a week now How
long we should keep testing
Image Pixabay
Do we really need to keep 6 feet of distance between our coworkers in the break room
Yes
bull Maintain at least 6 feet distance from others especially when mask use is not feasible (such as during eating or drinking)
bull Decrease the number of employees in break areasbull Eat in shifts
bull Go outside to eat
bull Open up additional space for breaks
httpswwwcdcgovcoronavirus2019-ncovcommunityguidance-business-responsehtml for additional tips
Monday ndash Friday
730 AM ndash 930 AM Central Time
200 PM -400 PM Central Time
Call 402-552-2881
IP Office Hours
Questions and Answer SessionUse the QA box in the webinar platform to type a question Questions will be read aloud by the moderator
If your question is not answered during the webinar please either e-mail it to NE ICAP or call during our office hours to speak with one of our IPs
A transcript of the discussion will be made available on the ICAP website
Panelists today are
Dr Salman Ashraf salmanashrafunmceduKate Tyner RN BSN CIC ltynernebraskamedcomMargaret Drake MT(ASCP)CIC MargaretDrakeNebraskagovTeri Fitzgerald RN BSN CIC tfitzgeraldnebraskamedcomDr Ishrat Kamal-Ahmed IshratKamal-AhmednebraskagovAlisha Dorn BSN RN CIC adornnebraskamedcom
httpsicapnebraskamedcomcoronavirushttpsicapnebraskamedcomcovid-19-webinars
Questions and Answer Session
Use the QA box in the webinar platform to type a question Questions will be read aloud by the moderator in the order they are received
A transcript of the discussion will be made available on the ICAP website
Moderated by Mounica Soma MHA
httpsicapnebraskamedcomresources
Responses were provided based on information known on 6162020 and may become out of date
Guidance is being updated rapidly so users should look to CDC and NE DHHS guidance for updates
NETEC ndash NICSNebraska DHHS HAI-ARNebraska ICAP Small and Critical Access Hospitals-Outpatient Region VII Webinar on COVID-19 6162020
1 Do you see recommendation for masks or face coverings going away anytime soon
We donrsquot seeing the recommendation changing because we are still seeing community
transmission of COVID-19 As long as there is community transmission the use of masks or face
coverings will be recommended That is especially true because we see spread that is pre-
symptomatic or asymptomatic We expect the universal mask recommendation to continue at
least until an effective vaccine is developed
2 Do you have any guidance for hospitals in making the decision when it is appropriate to relax
visitor restrictions amp stop temperature checks on everyone Am I safe to assume mandatory
mask wear in a hospital setting will continue through this year and into next year
Visitor restrictions are being loosened in some hospitals allowing one visitor per one patient
Nebraska Medicine has not done this yet Decisions on this will depend on which hospital (and
what is going on inside that hospital) plus things like community transmission what region you
are in The issue is that we are seeing community transmission and sometimes transmission is
happening from people who have minimal symptoms they donrsquot feel ill and donrsquot recognize that
they have COVID-19 We are still seeing people identified when they come to our hospitals who
have fevers and donrsquot even realize that when they try to enter I think the temperature checks
will continue for as long as we have universal masking We will probably see loosening of visitor
restrictions as we go forward if the case counts continue to go down Nebraska Medicine has
continued to identity people who have symptoms and temperatures during the screening
process at the entries Another issue Nebraska Medicine has seen in its hospital and clinic
waiting rooms is to be able to adhere to social distancing if you allow each patient to bring along
a visitor With some of the seats marked off to stay empty Nebraska Medicinersquos clinic waiting
rooms are already at capacity just with the patients There are logistical issues when you
increase the number of people coming into the clinics and hospitals That is something you
need to consider in your facilityrsquos planning
3 In regards to eye protection If a person has a prescription safety glasses are those okay for
use Does the eye protection need to be cleaned when going in and out of patient rooms Do
they need to clean after each patient (non-COVID) if glasses didnt visible become soiled
The prescription safety glasses could be allowed if they are OSHA-approved and we knew where
they were acquired For going in and out of patient rooms Nebraska Medicine treats the eye
protection like other extended use PPE The staff member does not touch the eye protection
and if they do then they do remove them and clean them with disinfectant wipes That also
applies if the eye protection becomes visibly soiled they are taken off and disinfected
Otherwise staff is allowed to continue to keep the eye protection on and wear them for an
extended period of time
4 What is the logic for mass testing long-term care staff prior to Phase II What real benefit is a
snap shot in time test result when you are in a situation that staff come and go between
multiple facilities Can go out in the community without restrictions no accountability to
mask andor social distance The reality is you cant control what staff do in the community
We agree that it is important to know that you cannot control what staff does out in the
community but we can educate staff to follow social distancing and masking in the community
Baseline testing does give you an idea what is going on in your facility at the time when you are
considering opening up or relaxing some of the restrictions It gives you a basic idea of your
facility situation If you do a staff testing and that day the entire staff is negative you know your
risk is lower in your facility and you can start reopening with more confidence If you do find a
number of staff positive when you test it is a sign that you may need to wait to relax
restrictions It is also a sign that there could be residents who are COVID-19 positive that you do
not know about who are asymptomatically or pre-symptomatically positive If you were to open
up at that time there may be increased transmission within the home Thatrsquos because when
you go from Phase I to Phase 2 to Phase 3 you would be increasing activities and resident to
resident interaction in the nursing home Staff testing also gives you an idea of what is going on
with the residents because if all the staff are negative chances are that all the residents would
be negative as well The residents are only getting from the staff at this time so if the staff is all
negative it shows they probably are doing the right thing out in the community or that there is
not much COVID-19 in their community right now
5 Since long-term care facilities are being required to test as a baseline will hospital staff also
need to be tested for a baseline
Nursing home residents are a unique population because they are living in a congregate
community Long term care staff are being tested first because it also gives us approximate
measures of what may be going on in the resident population We know that when restrictions
are being lifted the residents will start interacting with each other again and we want to identify
any positive residents before that happens to avoid transmission Those decisions are being
made by the state and we provide guidance but the statersquos decision are ultimately made by
them The hospitals donrsquot have the same situation where patients are interacting with each
other so that risk factor for transmission of COVID-19 isnrsquot present Hospital staff still needs to
be screened and vigilant and everyone has to wear surgical masks for source control and
personal protection But the situations of care are different so that is why long term care staff
is being tested on a baseline and not hospital staff is being tested on a baseline
6 Is all cautery in surgery a risk or just cautery when it involves the nasal or laryngeal areas
Not all cautery in surgery is the same risk Abdominal cautery would not carry the same risk as
nasal or laryngeal cautery which involves the respiratory system Nebraska Medicine follows
this same idea where there isnrsquot risk involved in cautery on legs arms etc
7 Have long-term care facilities been advised by ICAP to not allow admissions into their facilities
until no one (employee or patients) tests positive
The only time that a facility is not going to have admission is if they cannot take care of the
patient they are admitting (the CMS rule refers to not having the capacity the staff expertise or
the PPE to care for patients) A facility that does not have a way to cohort any existing COVID-19
positive patients or have room to take more patients safely is the only time we would tell a
facility not to admit patients There is guidance about admitting a COVID positive patients ndash if
they are within the 28-day time period they should have a two-test negative before they are
admitted especially if they are going into a facility that has not had a COVID-19 case before
because they wonrsquot have a red zone in place If a facility has already had a COVID-19 positive
case and have a red zone in place (separated from the rest of the facility and they have room
there for another positive patient) that is fine There are a lot of case-by-case decisions to be
made
8 Is there anything guidance I could share with staff not to double their maskswearing a N-95
with a surgical mask over top There is concern to conserve their PPE if wearing goggles that
this helps but concern about compromising the fit as well as comfort
This is an issue of how much PPE you have during this time of inventory shortages You still
want PPE worn correctly so the staff can be directed on the correct way You probably need to
talk to the staff to find out reasons for their concern in not following the protocol for wearing
PPE ndash concern over not having enough N95 masks to wear etc Those should be addressed
You can let ICAP know if you are short of PPE so we can try to help with acquisition of PPE
reprocessing etc Keep control over inventory so they arenrsquot taking PPE that they donrsquot need
Someone on your staff can work with others on their PPE use In general we donrsquot recommend
wearing a surgical mask over an N95 A face shield is a different strategy that can be used over
an N95 We still want to limit the use of N95 to one shift per mask Nebraska Medicine has
seen the use migrate to using an N95 mask (down from using face shields extra procedure
masks) etc and they have not seen COVID transmission or increased burn rates for N95 masks
9 For Alisha in OR when wearing goggles over a face shield do you just have reprocess after
that wear
No you just need to wipe them with disinfectant wipes once you take them off They are not
reprocessed
Basic CDC Guidance on Re-openingStill HoldsBefore expanding to provide elective services healthcare systems must operate without crisis standards of care
bull Ensure adequate
bull HCP staffing
bull bed capacity
bull availability of personal protective equipment and other supplies
httpswwwcdcgovcoronavirus2019-ncovhcpframework-non-COVID-carehtml
Importance of local COVID-19 transmission data bull Substantial community transmission Large-scale community
transmission including within communal settings (eg schools workplaces)
bull Minimal to moderate community transmission Sustained transmission with high likelihood or confirmed exposure within communal settings and potential for rapid increase in cases
bull No to minimal community transmission Evidence of isolated cases or limited community transmission case investigations underway no evidence of exposure in large communal setting
From broad guidance to the local level
bull Joint Statement Roadmap for Resuming Elective Surgery after COVID-19 Pandemic
ldquoFacilities should use available testing to protect staff and patient safety whenever possible and should implement a policy addressing requirements and frequency for patient and staff testingrdquo
httpswwwaornorgguidelinesaorn-supportroadmap-for-resuming-elective-surgery-after-covid-19
Non-operative and Ambulatory Pre-Procedure Testing for COVID-19 Testing is not mandatory for procedures in which the risk of airway compromise is considered low (local anesthetic mild sedation or select moderate sedation cases) IF
bull Patients who are asymptomatic and can wear a procedure mask at all times
bull Patients who are asymptomatic and mask cannot be worn for a short period (lt15 minutes) during the procedure but all staff wear procedure masks
httpswwwnebraskamedcomsitesdefaultfilesdocumentscovid-19procedural-guidance-for-low-risk-procedures05112020pdf
Non-operative and Ambulatory Pre-Procedure Testing for COVID-19
Non-operative and Ambulatory Pre-Procedure Testing Guidancebull High-risk aerosol-generating procedures(AGPs) are defined within the
perioperative guidance and includebull surgery anywhere within the upper respiratory tract
bull flexible bronchoscopy
bull Rhinoscopy
bull laryngoscopy (including intubation)
bull GI endoscopy procedures with need for sedation or spinal anesthetic that have a high likelihood of requiring manual (bag valve mask) ventilation or intubation ( such as TEE ECT cardioversion C-section)
bull ENTOMFSDental procedures utilizing cautery laser drill or saw within the airway or oral cavity
httpswwwnebraskamedcomsitesdefaultfilesdocumentscovid-19procedural-guidance-for-low-risk-procedures05112020pdf
When COVID-19 Testing for patients shouldbe donebull COVID19 pre-procedural testing is mandatory for elective procedures
requiring deep sedationanalgesia and anesthesia
bull Patient has any symptoms concerning for COVID19 Symptomatic patients must be evaluated and procedures should be deferred until acute illness has resolved (per other guidance) If COVID19+ will need to defer procedure if possible If urgent COVID19 level precautions should be taken
bull In cases where Infection Control has approved specific guidance unique to a specialty such as Dentistry Interventional Radiology ECT
httpswwwnebraskamedcomsitesdefaultfilesdocumentscovid-19procedural-guidance-for-low-risk-procedures05112020pdf
Perioperative Testing Guidance
bull Complex and multi-factorial
bull Advise looking at all of the resources
httpswwwnebraskamedcomfor-providerscovid19operating-room-procedures
-
httpswwwnebraskamedcomsitesdefaultfilesdocumentscovid-19preprocedural-testing-algorithm-for-covid-positive-patientspdf
Pre-procedure testing
AORN httpswwwaornorgguidelinesaorn-supportroadmap-for-resuming-elective-surgery-after-covid-19
Facilities should use available testing to protect staff and patient safety whenever possible
CHI httpswwwchihealthcomenpatients-visitorscoronavirus-covid-19covid-19-elective-surgery-precautionshtml
ldquoRequiring COVID-19 testing for patients prior to certain procedures to provide appropriate care and to reduce the risk of infection for caregiversrdquo
Frequently Asked Questions
Should we see nursing home patients in our clinics Arenrsquot they really high risk for bringing COVID-19 into the facility
Image Pixabay
Yes
bull Long-term care facilities have had stringent infection control processes since March
bull Recommend use of a procedure mask for the residentbull Plus procedure mask for HCW for non-COVID-19 visits
bull Plus N95 respirator gown gloves eye protection for COVID-19 visits
Is there a tool to help me plan for or quantify a potential surge in COVID-19 cases
Image Pixabay
Yes
Here is a CDC tool for calculating a surge in your community
httpswwwcdcgovcoronavirus2019-ncovhcpCOVIDSurgehtml [cdcgov]
It has been a month since our resident was tested positive and he is
still testing positive although asymptomatic for a week now How
long we should keep testing
Image Pixabay
Do we really need to keep 6 feet of distance between our coworkers in the break room
Yes
bull Maintain at least 6 feet distance from others especially when mask use is not feasible (such as during eating or drinking)
bull Decrease the number of employees in break areasbull Eat in shifts
bull Go outside to eat
bull Open up additional space for breaks
httpswwwcdcgovcoronavirus2019-ncovcommunityguidance-business-responsehtml for additional tips
Monday ndash Friday
730 AM ndash 930 AM Central Time
200 PM -400 PM Central Time
Call 402-552-2881
IP Office Hours
Questions and Answer SessionUse the QA box in the webinar platform to type a question Questions will be read aloud by the moderator
If your question is not answered during the webinar please either e-mail it to NE ICAP or call during our office hours to speak with one of our IPs
A transcript of the discussion will be made available on the ICAP website
Panelists today are
Dr Salman Ashraf salmanashrafunmceduKate Tyner RN BSN CIC ltynernebraskamedcomMargaret Drake MT(ASCP)CIC MargaretDrakeNebraskagovTeri Fitzgerald RN BSN CIC tfitzgeraldnebraskamedcomDr Ishrat Kamal-Ahmed IshratKamal-AhmednebraskagovAlisha Dorn BSN RN CIC adornnebraskamedcom
httpsicapnebraskamedcomcoronavirushttpsicapnebraskamedcomcovid-19-webinars
Questions and Answer Session
Use the QA box in the webinar platform to type a question Questions will be read aloud by the moderator in the order they are received
A transcript of the discussion will be made available on the ICAP website
Moderated by Mounica Soma MHA
httpsicapnebraskamedcomresources
Responses were provided based on information known on 6162020 and may become out of date
Guidance is being updated rapidly so users should look to CDC and NE DHHS guidance for updates
NETEC ndash NICSNebraska DHHS HAI-ARNebraska ICAP Small and Critical Access Hospitals-Outpatient Region VII Webinar on COVID-19 6162020
1 Do you see recommendation for masks or face coverings going away anytime soon
We donrsquot seeing the recommendation changing because we are still seeing community
transmission of COVID-19 As long as there is community transmission the use of masks or face
coverings will be recommended That is especially true because we see spread that is pre-
symptomatic or asymptomatic We expect the universal mask recommendation to continue at
least until an effective vaccine is developed
2 Do you have any guidance for hospitals in making the decision when it is appropriate to relax
visitor restrictions amp stop temperature checks on everyone Am I safe to assume mandatory
mask wear in a hospital setting will continue through this year and into next year
Visitor restrictions are being loosened in some hospitals allowing one visitor per one patient
Nebraska Medicine has not done this yet Decisions on this will depend on which hospital (and
what is going on inside that hospital) plus things like community transmission what region you
are in The issue is that we are seeing community transmission and sometimes transmission is
happening from people who have minimal symptoms they donrsquot feel ill and donrsquot recognize that
they have COVID-19 We are still seeing people identified when they come to our hospitals who
have fevers and donrsquot even realize that when they try to enter I think the temperature checks
will continue for as long as we have universal masking We will probably see loosening of visitor
restrictions as we go forward if the case counts continue to go down Nebraska Medicine has
continued to identity people who have symptoms and temperatures during the screening
process at the entries Another issue Nebraska Medicine has seen in its hospital and clinic
waiting rooms is to be able to adhere to social distancing if you allow each patient to bring along
a visitor With some of the seats marked off to stay empty Nebraska Medicinersquos clinic waiting
rooms are already at capacity just with the patients There are logistical issues when you
increase the number of people coming into the clinics and hospitals That is something you
need to consider in your facilityrsquos planning
3 In regards to eye protection If a person has a prescription safety glasses are those okay for
use Does the eye protection need to be cleaned when going in and out of patient rooms Do
they need to clean after each patient (non-COVID) if glasses didnt visible become soiled
The prescription safety glasses could be allowed if they are OSHA-approved and we knew where
they were acquired For going in and out of patient rooms Nebraska Medicine treats the eye
protection like other extended use PPE The staff member does not touch the eye protection
and if they do then they do remove them and clean them with disinfectant wipes That also
applies if the eye protection becomes visibly soiled they are taken off and disinfected
Otherwise staff is allowed to continue to keep the eye protection on and wear them for an
extended period of time
4 What is the logic for mass testing long-term care staff prior to Phase II What real benefit is a
snap shot in time test result when you are in a situation that staff come and go between
multiple facilities Can go out in the community without restrictions no accountability to
mask andor social distance The reality is you cant control what staff do in the community
We agree that it is important to know that you cannot control what staff does out in the
community but we can educate staff to follow social distancing and masking in the community
Baseline testing does give you an idea what is going on in your facility at the time when you are
considering opening up or relaxing some of the restrictions It gives you a basic idea of your
facility situation If you do a staff testing and that day the entire staff is negative you know your
risk is lower in your facility and you can start reopening with more confidence If you do find a
number of staff positive when you test it is a sign that you may need to wait to relax
restrictions It is also a sign that there could be residents who are COVID-19 positive that you do
not know about who are asymptomatically or pre-symptomatically positive If you were to open
up at that time there may be increased transmission within the home Thatrsquos because when
you go from Phase I to Phase 2 to Phase 3 you would be increasing activities and resident to
resident interaction in the nursing home Staff testing also gives you an idea of what is going on
with the residents because if all the staff are negative chances are that all the residents would
be negative as well The residents are only getting from the staff at this time so if the staff is all
negative it shows they probably are doing the right thing out in the community or that there is
not much COVID-19 in their community right now
5 Since long-term care facilities are being required to test as a baseline will hospital staff also
need to be tested for a baseline
Nursing home residents are a unique population because they are living in a congregate
community Long term care staff are being tested first because it also gives us approximate
measures of what may be going on in the resident population We know that when restrictions
are being lifted the residents will start interacting with each other again and we want to identify
any positive residents before that happens to avoid transmission Those decisions are being
made by the state and we provide guidance but the statersquos decision are ultimately made by
them The hospitals donrsquot have the same situation where patients are interacting with each
other so that risk factor for transmission of COVID-19 isnrsquot present Hospital staff still needs to
be screened and vigilant and everyone has to wear surgical masks for source control and
personal protection But the situations of care are different so that is why long term care staff
is being tested on a baseline and not hospital staff is being tested on a baseline
6 Is all cautery in surgery a risk or just cautery when it involves the nasal or laryngeal areas
Not all cautery in surgery is the same risk Abdominal cautery would not carry the same risk as
nasal or laryngeal cautery which involves the respiratory system Nebraska Medicine follows
this same idea where there isnrsquot risk involved in cautery on legs arms etc
7 Have long-term care facilities been advised by ICAP to not allow admissions into their facilities
until no one (employee or patients) tests positive
The only time that a facility is not going to have admission is if they cannot take care of the
patient they are admitting (the CMS rule refers to not having the capacity the staff expertise or
the PPE to care for patients) A facility that does not have a way to cohort any existing COVID-19
positive patients or have room to take more patients safely is the only time we would tell a
facility not to admit patients There is guidance about admitting a COVID positive patients ndash if
they are within the 28-day time period they should have a two-test negative before they are
admitted especially if they are going into a facility that has not had a COVID-19 case before
because they wonrsquot have a red zone in place If a facility has already had a COVID-19 positive
case and have a red zone in place (separated from the rest of the facility and they have room
there for another positive patient) that is fine There are a lot of case-by-case decisions to be
made
8 Is there anything guidance I could share with staff not to double their maskswearing a N-95
with a surgical mask over top There is concern to conserve their PPE if wearing goggles that
this helps but concern about compromising the fit as well as comfort
This is an issue of how much PPE you have during this time of inventory shortages You still
want PPE worn correctly so the staff can be directed on the correct way You probably need to
talk to the staff to find out reasons for their concern in not following the protocol for wearing
PPE ndash concern over not having enough N95 masks to wear etc Those should be addressed
You can let ICAP know if you are short of PPE so we can try to help with acquisition of PPE
reprocessing etc Keep control over inventory so they arenrsquot taking PPE that they donrsquot need
Someone on your staff can work with others on their PPE use In general we donrsquot recommend
wearing a surgical mask over an N95 A face shield is a different strategy that can be used over
an N95 We still want to limit the use of N95 to one shift per mask Nebraska Medicine has
seen the use migrate to using an N95 mask (down from using face shields extra procedure
masks) etc and they have not seen COVID transmission or increased burn rates for N95 masks
9 For Alisha in OR when wearing goggles over a face shield do you just have reprocess after
that wear
No you just need to wipe them with disinfectant wipes once you take them off They are not
reprocessed
Importance of local COVID-19 transmission data bull Substantial community transmission Large-scale community
transmission including within communal settings (eg schools workplaces)
bull Minimal to moderate community transmission Sustained transmission with high likelihood or confirmed exposure within communal settings and potential for rapid increase in cases
bull No to minimal community transmission Evidence of isolated cases or limited community transmission case investigations underway no evidence of exposure in large communal setting
From broad guidance to the local level
bull Joint Statement Roadmap for Resuming Elective Surgery after COVID-19 Pandemic
ldquoFacilities should use available testing to protect staff and patient safety whenever possible and should implement a policy addressing requirements and frequency for patient and staff testingrdquo
httpswwwaornorgguidelinesaorn-supportroadmap-for-resuming-elective-surgery-after-covid-19
Non-operative and Ambulatory Pre-Procedure Testing for COVID-19 Testing is not mandatory for procedures in which the risk of airway compromise is considered low (local anesthetic mild sedation or select moderate sedation cases) IF
bull Patients who are asymptomatic and can wear a procedure mask at all times
bull Patients who are asymptomatic and mask cannot be worn for a short period (lt15 minutes) during the procedure but all staff wear procedure masks
httpswwwnebraskamedcomsitesdefaultfilesdocumentscovid-19procedural-guidance-for-low-risk-procedures05112020pdf
Non-operative and Ambulatory Pre-Procedure Testing for COVID-19
Non-operative and Ambulatory Pre-Procedure Testing Guidancebull High-risk aerosol-generating procedures(AGPs) are defined within the
perioperative guidance and includebull surgery anywhere within the upper respiratory tract
bull flexible bronchoscopy
bull Rhinoscopy
bull laryngoscopy (including intubation)
bull GI endoscopy procedures with need for sedation or spinal anesthetic that have a high likelihood of requiring manual (bag valve mask) ventilation or intubation ( such as TEE ECT cardioversion C-section)
bull ENTOMFSDental procedures utilizing cautery laser drill or saw within the airway or oral cavity
httpswwwnebraskamedcomsitesdefaultfilesdocumentscovid-19procedural-guidance-for-low-risk-procedures05112020pdf
When COVID-19 Testing for patients shouldbe donebull COVID19 pre-procedural testing is mandatory for elective procedures
requiring deep sedationanalgesia and anesthesia
bull Patient has any symptoms concerning for COVID19 Symptomatic patients must be evaluated and procedures should be deferred until acute illness has resolved (per other guidance) If COVID19+ will need to defer procedure if possible If urgent COVID19 level precautions should be taken
bull In cases where Infection Control has approved specific guidance unique to a specialty such as Dentistry Interventional Radiology ECT
httpswwwnebraskamedcomsitesdefaultfilesdocumentscovid-19procedural-guidance-for-low-risk-procedures05112020pdf
Perioperative Testing Guidance
bull Complex and multi-factorial
bull Advise looking at all of the resources
httpswwwnebraskamedcomfor-providerscovid19operating-room-procedures
-
httpswwwnebraskamedcomsitesdefaultfilesdocumentscovid-19preprocedural-testing-algorithm-for-covid-positive-patientspdf
Pre-procedure testing
AORN httpswwwaornorgguidelinesaorn-supportroadmap-for-resuming-elective-surgery-after-covid-19
Facilities should use available testing to protect staff and patient safety whenever possible
CHI httpswwwchihealthcomenpatients-visitorscoronavirus-covid-19covid-19-elective-surgery-precautionshtml
ldquoRequiring COVID-19 testing for patients prior to certain procedures to provide appropriate care and to reduce the risk of infection for caregiversrdquo
Frequently Asked Questions
Should we see nursing home patients in our clinics Arenrsquot they really high risk for bringing COVID-19 into the facility
Image Pixabay
Yes
bull Long-term care facilities have had stringent infection control processes since March
bull Recommend use of a procedure mask for the residentbull Plus procedure mask for HCW for non-COVID-19 visits
bull Plus N95 respirator gown gloves eye protection for COVID-19 visits
Is there a tool to help me plan for or quantify a potential surge in COVID-19 cases
Image Pixabay
Yes
Here is a CDC tool for calculating a surge in your community
httpswwwcdcgovcoronavirus2019-ncovhcpCOVIDSurgehtml [cdcgov]
It has been a month since our resident was tested positive and he is
still testing positive although asymptomatic for a week now How
long we should keep testing
Image Pixabay
Do we really need to keep 6 feet of distance between our coworkers in the break room
Yes
bull Maintain at least 6 feet distance from others especially when mask use is not feasible (such as during eating or drinking)
bull Decrease the number of employees in break areasbull Eat in shifts
bull Go outside to eat
bull Open up additional space for breaks
httpswwwcdcgovcoronavirus2019-ncovcommunityguidance-business-responsehtml for additional tips
Monday ndash Friday
730 AM ndash 930 AM Central Time
200 PM -400 PM Central Time
Call 402-552-2881
IP Office Hours
Questions and Answer SessionUse the QA box in the webinar platform to type a question Questions will be read aloud by the moderator
If your question is not answered during the webinar please either e-mail it to NE ICAP or call during our office hours to speak with one of our IPs
A transcript of the discussion will be made available on the ICAP website
Panelists today are
Dr Salman Ashraf salmanashrafunmceduKate Tyner RN BSN CIC ltynernebraskamedcomMargaret Drake MT(ASCP)CIC MargaretDrakeNebraskagovTeri Fitzgerald RN BSN CIC tfitzgeraldnebraskamedcomDr Ishrat Kamal-Ahmed IshratKamal-AhmednebraskagovAlisha Dorn BSN RN CIC adornnebraskamedcom
httpsicapnebraskamedcomcoronavirushttpsicapnebraskamedcomcovid-19-webinars
Questions and Answer Session
Use the QA box in the webinar platform to type a question Questions will be read aloud by the moderator in the order they are received
A transcript of the discussion will be made available on the ICAP website
Moderated by Mounica Soma MHA
httpsicapnebraskamedcomresources
Responses were provided based on information known on 6162020 and may become out of date
Guidance is being updated rapidly so users should look to CDC and NE DHHS guidance for updates
NETEC ndash NICSNebraska DHHS HAI-ARNebraska ICAP Small and Critical Access Hospitals-Outpatient Region VII Webinar on COVID-19 6162020
1 Do you see recommendation for masks or face coverings going away anytime soon
We donrsquot seeing the recommendation changing because we are still seeing community
transmission of COVID-19 As long as there is community transmission the use of masks or face
coverings will be recommended That is especially true because we see spread that is pre-
symptomatic or asymptomatic We expect the universal mask recommendation to continue at
least until an effective vaccine is developed
2 Do you have any guidance for hospitals in making the decision when it is appropriate to relax
visitor restrictions amp stop temperature checks on everyone Am I safe to assume mandatory
mask wear in a hospital setting will continue through this year and into next year
Visitor restrictions are being loosened in some hospitals allowing one visitor per one patient
Nebraska Medicine has not done this yet Decisions on this will depend on which hospital (and
what is going on inside that hospital) plus things like community transmission what region you
are in The issue is that we are seeing community transmission and sometimes transmission is
happening from people who have minimal symptoms they donrsquot feel ill and donrsquot recognize that
they have COVID-19 We are still seeing people identified when they come to our hospitals who
have fevers and donrsquot even realize that when they try to enter I think the temperature checks
will continue for as long as we have universal masking We will probably see loosening of visitor
restrictions as we go forward if the case counts continue to go down Nebraska Medicine has
continued to identity people who have symptoms and temperatures during the screening
process at the entries Another issue Nebraska Medicine has seen in its hospital and clinic
waiting rooms is to be able to adhere to social distancing if you allow each patient to bring along
a visitor With some of the seats marked off to stay empty Nebraska Medicinersquos clinic waiting
rooms are already at capacity just with the patients There are logistical issues when you
increase the number of people coming into the clinics and hospitals That is something you
need to consider in your facilityrsquos planning
3 In regards to eye protection If a person has a prescription safety glasses are those okay for
use Does the eye protection need to be cleaned when going in and out of patient rooms Do
they need to clean after each patient (non-COVID) if glasses didnt visible become soiled
The prescription safety glasses could be allowed if they are OSHA-approved and we knew where
they were acquired For going in and out of patient rooms Nebraska Medicine treats the eye
protection like other extended use PPE The staff member does not touch the eye protection
and if they do then they do remove them and clean them with disinfectant wipes That also
applies if the eye protection becomes visibly soiled they are taken off and disinfected
Otherwise staff is allowed to continue to keep the eye protection on and wear them for an
extended period of time
4 What is the logic for mass testing long-term care staff prior to Phase II What real benefit is a
snap shot in time test result when you are in a situation that staff come and go between
multiple facilities Can go out in the community without restrictions no accountability to
mask andor social distance The reality is you cant control what staff do in the community
We agree that it is important to know that you cannot control what staff does out in the
community but we can educate staff to follow social distancing and masking in the community
Baseline testing does give you an idea what is going on in your facility at the time when you are
considering opening up or relaxing some of the restrictions It gives you a basic idea of your
facility situation If you do a staff testing and that day the entire staff is negative you know your
risk is lower in your facility and you can start reopening with more confidence If you do find a
number of staff positive when you test it is a sign that you may need to wait to relax
restrictions It is also a sign that there could be residents who are COVID-19 positive that you do
not know about who are asymptomatically or pre-symptomatically positive If you were to open
up at that time there may be increased transmission within the home Thatrsquos because when
you go from Phase I to Phase 2 to Phase 3 you would be increasing activities and resident to
resident interaction in the nursing home Staff testing also gives you an idea of what is going on
with the residents because if all the staff are negative chances are that all the residents would
be negative as well The residents are only getting from the staff at this time so if the staff is all
negative it shows they probably are doing the right thing out in the community or that there is
not much COVID-19 in their community right now
5 Since long-term care facilities are being required to test as a baseline will hospital staff also
need to be tested for a baseline
Nursing home residents are a unique population because they are living in a congregate
community Long term care staff are being tested first because it also gives us approximate
measures of what may be going on in the resident population We know that when restrictions
are being lifted the residents will start interacting with each other again and we want to identify
any positive residents before that happens to avoid transmission Those decisions are being
made by the state and we provide guidance but the statersquos decision are ultimately made by
them The hospitals donrsquot have the same situation where patients are interacting with each
other so that risk factor for transmission of COVID-19 isnrsquot present Hospital staff still needs to
be screened and vigilant and everyone has to wear surgical masks for source control and
personal protection But the situations of care are different so that is why long term care staff
is being tested on a baseline and not hospital staff is being tested on a baseline
6 Is all cautery in surgery a risk or just cautery when it involves the nasal or laryngeal areas
Not all cautery in surgery is the same risk Abdominal cautery would not carry the same risk as
nasal or laryngeal cautery which involves the respiratory system Nebraska Medicine follows
this same idea where there isnrsquot risk involved in cautery on legs arms etc
7 Have long-term care facilities been advised by ICAP to not allow admissions into their facilities
until no one (employee or patients) tests positive
The only time that a facility is not going to have admission is if they cannot take care of the
patient they are admitting (the CMS rule refers to not having the capacity the staff expertise or
the PPE to care for patients) A facility that does not have a way to cohort any existing COVID-19
positive patients or have room to take more patients safely is the only time we would tell a
facility not to admit patients There is guidance about admitting a COVID positive patients ndash if
they are within the 28-day time period they should have a two-test negative before they are
admitted especially if they are going into a facility that has not had a COVID-19 case before
because they wonrsquot have a red zone in place If a facility has already had a COVID-19 positive
case and have a red zone in place (separated from the rest of the facility and they have room
there for another positive patient) that is fine There are a lot of case-by-case decisions to be
made
8 Is there anything guidance I could share with staff not to double their maskswearing a N-95
with a surgical mask over top There is concern to conserve their PPE if wearing goggles that
this helps but concern about compromising the fit as well as comfort
This is an issue of how much PPE you have during this time of inventory shortages You still
want PPE worn correctly so the staff can be directed on the correct way You probably need to
talk to the staff to find out reasons for their concern in not following the protocol for wearing
PPE ndash concern over not having enough N95 masks to wear etc Those should be addressed
You can let ICAP know if you are short of PPE so we can try to help with acquisition of PPE
reprocessing etc Keep control over inventory so they arenrsquot taking PPE that they donrsquot need
Someone on your staff can work with others on their PPE use In general we donrsquot recommend
wearing a surgical mask over an N95 A face shield is a different strategy that can be used over
an N95 We still want to limit the use of N95 to one shift per mask Nebraska Medicine has
seen the use migrate to using an N95 mask (down from using face shields extra procedure
masks) etc and they have not seen COVID transmission or increased burn rates for N95 masks
9 For Alisha in OR when wearing goggles over a face shield do you just have reprocess after
that wear
No you just need to wipe them with disinfectant wipes once you take them off They are not
reprocessed
From broad guidance to the local level
bull Joint Statement Roadmap for Resuming Elective Surgery after COVID-19 Pandemic
ldquoFacilities should use available testing to protect staff and patient safety whenever possible and should implement a policy addressing requirements and frequency for patient and staff testingrdquo
httpswwwaornorgguidelinesaorn-supportroadmap-for-resuming-elective-surgery-after-covid-19
Non-operative and Ambulatory Pre-Procedure Testing for COVID-19 Testing is not mandatory for procedures in which the risk of airway compromise is considered low (local anesthetic mild sedation or select moderate sedation cases) IF
bull Patients who are asymptomatic and can wear a procedure mask at all times
bull Patients who are asymptomatic and mask cannot be worn for a short period (lt15 minutes) during the procedure but all staff wear procedure masks
httpswwwnebraskamedcomsitesdefaultfilesdocumentscovid-19procedural-guidance-for-low-risk-procedures05112020pdf
Non-operative and Ambulatory Pre-Procedure Testing for COVID-19
Non-operative and Ambulatory Pre-Procedure Testing Guidancebull High-risk aerosol-generating procedures(AGPs) are defined within the
perioperative guidance and includebull surgery anywhere within the upper respiratory tract
bull flexible bronchoscopy
bull Rhinoscopy
bull laryngoscopy (including intubation)
bull GI endoscopy procedures with need for sedation or spinal anesthetic that have a high likelihood of requiring manual (bag valve mask) ventilation or intubation ( such as TEE ECT cardioversion C-section)
bull ENTOMFSDental procedures utilizing cautery laser drill or saw within the airway or oral cavity
httpswwwnebraskamedcomsitesdefaultfilesdocumentscovid-19procedural-guidance-for-low-risk-procedures05112020pdf
When COVID-19 Testing for patients shouldbe donebull COVID19 pre-procedural testing is mandatory for elective procedures
requiring deep sedationanalgesia and anesthesia
bull Patient has any symptoms concerning for COVID19 Symptomatic patients must be evaluated and procedures should be deferred until acute illness has resolved (per other guidance) If COVID19+ will need to defer procedure if possible If urgent COVID19 level precautions should be taken
bull In cases where Infection Control has approved specific guidance unique to a specialty such as Dentistry Interventional Radiology ECT
httpswwwnebraskamedcomsitesdefaultfilesdocumentscovid-19procedural-guidance-for-low-risk-procedures05112020pdf
Perioperative Testing Guidance
bull Complex and multi-factorial
bull Advise looking at all of the resources
httpswwwnebraskamedcomfor-providerscovid19operating-room-procedures
-
httpswwwnebraskamedcomsitesdefaultfilesdocumentscovid-19preprocedural-testing-algorithm-for-covid-positive-patientspdf
Pre-procedure testing
AORN httpswwwaornorgguidelinesaorn-supportroadmap-for-resuming-elective-surgery-after-covid-19
Facilities should use available testing to protect staff and patient safety whenever possible
CHI httpswwwchihealthcomenpatients-visitorscoronavirus-covid-19covid-19-elective-surgery-precautionshtml
ldquoRequiring COVID-19 testing for patients prior to certain procedures to provide appropriate care and to reduce the risk of infection for caregiversrdquo
Frequently Asked Questions
Should we see nursing home patients in our clinics Arenrsquot they really high risk for bringing COVID-19 into the facility
Image Pixabay
Yes
bull Long-term care facilities have had stringent infection control processes since March
bull Recommend use of a procedure mask for the residentbull Plus procedure mask for HCW for non-COVID-19 visits
bull Plus N95 respirator gown gloves eye protection for COVID-19 visits
Is there a tool to help me plan for or quantify a potential surge in COVID-19 cases
Image Pixabay
Yes
Here is a CDC tool for calculating a surge in your community
httpswwwcdcgovcoronavirus2019-ncovhcpCOVIDSurgehtml [cdcgov]
It has been a month since our resident was tested positive and he is
still testing positive although asymptomatic for a week now How
long we should keep testing
Image Pixabay
Do we really need to keep 6 feet of distance between our coworkers in the break room
Yes
bull Maintain at least 6 feet distance from others especially when mask use is not feasible (such as during eating or drinking)
bull Decrease the number of employees in break areasbull Eat in shifts
bull Go outside to eat
bull Open up additional space for breaks
httpswwwcdcgovcoronavirus2019-ncovcommunityguidance-business-responsehtml for additional tips
Monday ndash Friday
730 AM ndash 930 AM Central Time
200 PM -400 PM Central Time
Call 402-552-2881
IP Office Hours
Questions and Answer SessionUse the QA box in the webinar platform to type a question Questions will be read aloud by the moderator
If your question is not answered during the webinar please either e-mail it to NE ICAP or call during our office hours to speak with one of our IPs
A transcript of the discussion will be made available on the ICAP website
Panelists today are
Dr Salman Ashraf salmanashrafunmceduKate Tyner RN BSN CIC ltynernebraskamedcomMargaret Drake MT(ASCP)CIC MargaretDrakeNebraskagovTeri Fitzgerald RN BSN CIC tfitzgeraldnebraskamedcomDr Ishrat Kamal-Ahmed IshratKamal-AhmednebraskagovAlisha Dorn BSN RN CIC adornnebraskamedcom
httpsicapnebraskamedcomcoronavirushttpsicapnebraskamedcomcovid-19-webinars
Questions and Answer Session
Use the QA box in the webinar platform to type a question Questions will be read aloud by the moderator in the order they are received
A transcript of the discussion will be made available on the ICAP website
Moderated by Mounica Soma MHA
httpsicapnebraskamedcomresources
Responses were provided based on information known on 6162020 and may become out of date
Guidance is being updated rapidly so users should look to CDC and NE DHHS guidance for updates
NETEC ndash NICSNebraska DHHS HAI-ARNebraska ICAP Small and Critical Access Hospitals-Outpatient Region VII Webinar on COVID-19 6162020
1 Do you see recommendation for masks or face coverings going away anytime soon
We donrsquot seeing the recommendation changing because we are still seeing community
transmission of COVID-19 As long as there is community transmission the use of masks or face
coverings will be recommended That is especially true because we see spread that is pre-
symptomatic or asymptomatic We expect the universal mask recommendation to continue at
least until an effective vaccine is developed
2 Do you have any guidance for hospitals in making the decision when it is appropriate to relax
visitor restrictions amp stop temperature checks on everyone Am I safe to assume mandatory
mask wear in a hospital setting will continue through this year and into next year
Visitor restrictions are being loosened in some hospitals allowing one visitor per one patient
Nebraska Medicine has not done this yet Decisions on this will depend on which hospital (and
what is going on inside that hospital) plus things like community transmission what region you
are in The issue is that we are seeing community transmission and sometimes transmission is
happening from people who have minimal symptoms they donrsquot feel ill and donrsquot recognize that
they have COVID-19 We are still seeing people identified when they come to our hospitals who
have fevers and donrsquot even realize that when they try to enter I think the temperature checks
will continue for as long as we have universal masking We will probably see loosening of visitor
restrictions as we go forward if the case counts continue to go down Nebraska Medicine has
continued to identity people who have symptoms and temperatures during the screening
process at the entries Another issue Nebraska Medicine has seen in its hospital and clinic
waiting rooms is to be able to adhere to social distancing if you allow each patient to bring along
a visitor With some of the seats marked off to stay empty Nebraska Medicinersquos clinic waiting
rooms are already at capacity just with the patients There are logistical issues when you
increase the number of people coming into the clinics and hospitals That is something you
need to consider in your facilityrsquos planning
3 In regards to eye protection If a person has a prescription safety glasses are those okay for
use Does the eye protection need to be cleaned when going in and out of patient rooms Do
they need to clean after each patient (non-COVID) if glasses didnt visible become soiled
The prescription safety glasses could be allowed if they are OSHA-approved and we knew where
they were acquired For going in and out of patient rooms Nebraska Medicine treats the eye
protection like other extended use PPE The staff member does not touch the eye protection
and if they do then they do remove them and clean them with disinfectant wipes That also
applies if the eye protection becomes visibly soiled they are taken off and disinfected
Otherwise staff is allowed to continue to keep the eye protection on and wear them for an
extended period of time
4 What is the logic for mass testing long-term care staff prior to Phase II What real benefit is a
snap shot in time test result when you are in a situation that staff come and go between
multiple facilities Can go out in the community without restrictions no accountability to
mask andor social distance The reality is you cant control what staff do in the community
We agree that it is important to know that you cannot control what staff does out in the
community but we can educate staff to follow social distancing and masking in the community
Baseline testing does give you an idea what is going on in your facility at the time when you are
considering opening up or relaxing some of the restrictions It gives you a basic idea of your
facility situation If you do a staff testing and that day the entire staff is negative you know your
risk is lower in your facility and you can start reopening with more confidence If you do find a
number of staff positive when you test it is a sign that you may need to wait to relax
restrictions It is also a sign that there could be residents who are COVID-19 positive that you do
not know about who are asymptomatically or pre-symptomatically positive If you were to open
up at that time there may be increased transmission within the home Thatrsquos because when
you go from Phase I to Phase 2 to Phase 3 you would be increasing activities and resident to
resident interaction in the nursing home Staff testing also gives you an idea of what is going on
with the residents because if all the staff are negative chances are that all the residents would
be negative as well The residents are only getting from the staff at this time so if the staff is all
negative it shows they probably are doing the right thing out in the community or that there is
not much COVID-19 in their community right now
5 Since long-term care facilities are being required to test as a baseline will hospital staff also
need to be tested for a baseline
Nursing home residents are a unique population because they are living in a congregate
community Long term care staff are being tested first because it also gives us approximate
measures of what may be going on in the resident population We know that when restrictions
are being lifted the residents will start interacting with each other again and we want to identify
any positive residents before that happens to avoid transmission Those decisions are being
made by the state and we provide guidance but the statersquos decision are ultimately made by
them The hospitals donrsquot have the same situation where patients are interacting with each
other so that risk factor for transmission of COVID-19 isnrsquot present Hospital staff still needs to
be screened and vigilant and everyone has to wear surgical masks for source control and
personal protection But the situations of care are different so that is why long term care staff
is being tested on a baseline and not hospital staff is being tested on a baseline
6 Is all cautery in surgery a risk or just cautery when it involves the nasal or laryngeal areas
Not all cautery in surgery is the same risk Abdominal cautery would not carry the same risk as
nasal or laryngeal cautery which involves the respiratory system Nebraska Medicine follows
this same idea where there isnrsquot risk involved in cautery on legs arms etc
7 Have long-term care facilities been advised by ICAP to not allow admissions into their facilities
until no one (employee or patients) tests positive
The only time that a facility is not going to have admission is if they cannot take care of the
patient they are admitting (the CMS rule refers to not having the capacity the staff expertise or
the PPE to care for patients) A facility that does not have a way to cohort any existing COVID-19
positive patients or have room to take more patients safely is the only time we would tell a
facility not to admit patients There is guidance about admitting a COVID positive patients ndash if
they are within the 28-day time period they should have a two-test negative before they are
admitted especially if they are going into a facility that has not had a COVID-19 case before
because they wonrsquot have a red zone in place If a facility has already had a COVID-19 positive
case and have a red zone in place (separated from the rest of the facility and they have room
there for another positive patient) that is fine There are a lot of case-by-case decisions to be
made
8 Is there anything guidance I could share with staff not to double their maskswearing a N-95
with a surgical mask over top There is concern to conserve their PPE if wearing goggles that
this helps but concern about compromising the fit as well as comfort
This is an issue of how much PPE you have during this time of inventory shortages You still
want PPE worn correctly so the staff can be directed on the correct way You probably need to
talk to the staff to find out reasons for their concern in not following the protocol for wearing
PPE ndash concern over not having enough N95 masks to wear etc Those should be addressed
You can let ICAP know if you are short of PPE so we can try to help with acquisition of PPE
reprocessing etc Keep control over inventory so they arenrsquot taking PPE that they donrsquot need
Someone on your staff can work with others on their PPE use In general we donrsquot recommend
wearing a surgical mask over an N95 A face shield is a different strategy that can be used over
an N95 We still want to limit the use of N95 to one shift per mask Nebraska Medicine has
seen the use migrate to using an N95 mask (down from using face shields extra procedure
masks) etc and they have not seen COVID transmission or increased burn rates for N95 masks
9 For Alisha in OR when wearing goggles over a face shield do you just have reprocess after
that wear
No you just need to wipe them with disinfectant wipes once you take them off They are not
reprocessed
Non-operative and Ambulatory Pre-Procedure Testing for COVID-19 Testing is not mandatory for procedures in which the risk of airway compromise is considered low (local anesthetic mild sedation or select moderate sedation cases) IF
bull Patients who are asymptomatic and can wear a procedure mask at all times
bull Patients who are asymptomatic and mask cannot be worn for a short period (lt15 minutes) during the procedure but all staff wear procedure masks
httpswwwnebraskamedcomsitesdefaultfilesdocumentscovid-19procedural-guidance-for-low-risk-procedures05112020pdf
Non-operative and Ambulatory Pre-Procedure Testing for COVID-19
Non-operative and Ambulatory Pre-Procedure Testing Guidancebull High-risk aerosol-generating procedures(AGPs) are defined within the
perioperative guidance and includebull surgery anywhere within the upper respiratory tract
bull flexible bronchoscopy
bull Rhinoscopy
bull laryngoscopy (including intubation)
bull GI endoscopy procedures with need for sedation or spinal anesthetic that have a high likelihood of requiring manual (bag valve mask) ventilation or intubation ( such as TEE ECT cardioversion C-section)
bull ENTOMFSDental procedures utilizing cautery laser drill or saw within the airway or oral cavity
httpswwwnebraskamedcomsitesdefaultfilesdocumentscovid-19procedural-guidance-for-low-risk-procedures05112020pdf
When COVID-19 Testing for patients shouldbe donebull COVID19 pre-procedural testing is mandatory for elective procedures
requiring deep sedationanalgesia and anesthesia
bull Patient has any symptoms concerning for COVID19 Symptomatic patients must be evaluated and procedures should be deferred until acute illness has resolved (per other guidance) If COVID19+ will need to defer procedure if possible If urgent COVID19 level precautions should be taken
bull In cases where Infection Control has approved specific guidance unique to a specialty such as Dentistry Interventional Radiology ECT
httpswwwnebraskamedcomsitesdefaultfilesdocumentscovid-19procedural-guidance-for-low-risk-procedures05112020pdf
Perioperative Testing Guidance
bull Complex and multi-factorial
bull Advise looking at all of the resources
httpswwwnebraskamedcomfor-providerscovid19operating-room-procedures
-
httpswwwnebraskamedcomsitesdefaultfilesdocumentscovid-19preprocedural-testing-algorithm-for-covid-positive-patientspdf
Pre-procedure testing
AORN httpswwwaornorgguidelinesaorn-supportroadmap-for-resuming-elective-surgery-after-covid-19
Facilities should use available testing to protect staff and patient safety whenever possible
CHI httpswwwchihealthcomenpatients-visitorscoronavirus-covid-19covid-19-elective-surgery-precautionshtml
ldquoRequiring COVID-19 testing for patients prior to certain procedures to provide appropriate care and to reduce the risk of infection for caregiversrdquo
Frequently Asked Questions
Should we see nursing home patients in our clinics Arenrsquot they really high risk for bringing COVID-19 into the facility
Image Pixabay
Yes
bull Long-term care facilities have had stringent infection control processes since March
bull Recommend use of a procedure mask for the residentbull Plus procedure mask for HCW for non-COVID-19 visits
bull Plus N95 respirator gown gloves eye protection for COVID-19 visits
Is there a tool to help me plan for or quantify a potential surge in COVID-19 cases
Image Pixabay
Yes
Here is a CDC tool for calculating a surge in your community
httpswwwcdcgovcoronavirus2019-ncovhcpCOVIDSurgehtml [cdcgov]
It has been a month since our resident was tested positive and he is
still testing positive although asymptomatic for a week now How
long we should keep testing
Image Pixabay
Do we really need to keep 6 feet of distance between our coworkers in the break room
Yes
bull Maintain at least 6 feet distance from others especially when mask use is not feasible (such as during eating or drinking)
bull Decrease the number of employees in break areasbull Eat in shifts
bull Go outside to eat
bull Open up additional space for breaks
httpswwwcdcgovcoronavirus2019-ncovcommunityguidance-business-responsehtml for additional tips
Monday ndash Friday
730 AM ndash 930 AM Central Time
200 PM -400 PM Central Time
Call 402-552-2881
IP Office Hours
Questions and Answer SessionUse the QA box in the webinar platform to type a question Questions will be read aloud by the moderator
If your question is not answered during the webinar please either e-mail it to NE ICAP or call during our office hours to speak with one of our IPs
A transcript of the discussion will be made available on the ICAP website
Panelists today are
Dr Salman Ashraf salmanashrafunmceduKate Tyner RN BSN CIC ltynernebraskamedcomMargaret Drake MT(ASCP)CIC MargaretDrakeNebraskagovTeri Fitzgerald RN BSN CIC tfitzgeraldnebraskamedcomDr Ishrat Kamal-Ahmed IshratKamal-AhmednebraskagovAlisha Dorn BSN RN CIC adornnebraskamedcom
httpsicapnebraskamedcomcoronavirushttpsicapnebraskamedcomcovid-19-webinars
Questions and Answer Session
Use the QA box in the webinar platform to type a question Questions will be read aloud by the moderator in the order they are received
A transcript of the discussion will be made available on the ICAP website
Moderated by Mounica Soma MHA
httpsicapnebraskamedcomresources
Responses were provided based on information known on 6162020 and may become out of date
Guidance is being updated rapidly so users should look to CDC and NE DHHS guidance for updates
NETEC ndash NICSNebraska DHHS HAI-ARNebraska ICAP Small and Critical Access Hospitals-Outpatient Region VII Webinar on COVID-19 6162020
1 Do you see recommendation for masks or face coverings going away anytime soon
We donrsquot seeing the recommendation changing because we are still seeing community
transmission of COVID-19 As long as there is community transmission the use of masks or face
coverings will be recommended That is especially true because we see spread that is pre-
symptomatic or asymptomatic We expect the universal mask recommendation to continue at
least until an effective vaccine is developed
2 Do you have any guidance for hospitals in making the decision when it is appropriate to relax
visitor restrictions amp stop temperature checks on everyone Am I safe to assume mandatory
mask wear in a hospital setting will continue through this year and into next year
Visitor restrictions are being loosened in some hospitals allowing one visitor per one patient
Nebraska Medicine has not done this yet Decisions on this will depend on which hospital (and
what is going on inside that hospital) plus things like community transmission what region you
are in The issue is that we are seeing community transmission and sometimes transmission is
happening from people who have minimal symptoms they donrsquot feel ill and donrsquot recognize that
they have COVID-19 We are still seeing people identified when they come to our hospitals who
have fevers and donrsquot even realize that when they try to enter I think the temperature checks
will continue for as long as we have universal masking We will probably see loosening of visitor
restrictions as we go forward if the case counts continue to go down Nebraska Medicine has
continued to identity people who have symptoms and temperatures during the screening
process at the entries Another issue Nebraska Medicine has seen in its hospital and clinic
waiting rooms is to be able to adhere to social distancing if you allow each patient to bring along
a visitor With some of the seats marked off to stay empty Nebraska Medicinersquos clinic waiting
rooms are already at capacity just with the patients There are logistical issues when you
increase the number of people coming into the clinics and hospitals That is something you
need to consider in your facilityrsquos planning
3 In regards to eye protection If a person has a prescription safety glasses are those okay for
use Does the eye protection need to be cleaned when going in and out of patient rooms Do
they need to clean after each patient (non-COVID) if glasses didnt visible become soiled
The prescription safety glasses could be allowed if they are OSHA-approved and we knew where
they were acquired For going in and out of patient rooms Nebraska Medicine treats the eye
protection like other extended use PPE The staff member does not touch the eye protection
and if they do then they do remove them and clean them with disinfectant wipes That also
applies if the eye protection becomes visibly soiled they are taken off and disinfected
Otherwise staff is allowed to continue to keep the eye protection on and wear them for an
extended period of time
4 What is the logic for mass testing long-term care staff prior to Phase II What real benefit is a
snap shot in time test result when you are in a situation that staff come and go between
multiple facilities Can go out in the community without restrictions no accountability to
mask andor social distance The reality is you cant control what staff do in the community
We agree that it is important to know that you cannot control what staff does out in the
community but we can educate staff to follow social distancing and masking in the community
Baseline testing does give you an idea what is going on in your facility at the time when you are
considering opening up or relaxing some of the restrictions It gives you a basic idea of your
facility situation If you do a staff testing and that day the entire staff is negative you know your
risk is lower in your facility and you can start reopening with more confidence If you do find a
number of staff positive when you test it is a sign that you may need to wait to relax
restrictions It is also a sign that there could be residents who are COVID-19 positive that you do
not know about who are asymptomatically or pre-symptomatically positive If you were to open
up at that time there may be increased transmission within the home Thatrsquos because when
you go from Phase I to Phase 2 to Phase 3 you would be increasing activities and resident to
resident interaction in the nursing home Staff testing also gives you an idea of what is going on
with the residents because if all the staff are negative chances are that all the residents would
be negative as well The residents are only getting from the staff at this time so if the staff is all
negative it shows they probably are doing the right thing out in the community or that there is
not much COVID-19 in their community right now
5 Since long-term care facilities are being required to test as a baseline will hospital staff also
need to be tested for a baseline
Nursing home residents are a unique population because they are living in a congregate
community Long term care staff are being tested first because it also gives us approximate
measures of what may be going on in the resident population We know that when restrictions
are being lifted the residents will start interacting with each other again and we want to identify
any positive residents before that happens to avoid transmission Those decisions are being
made by the state and we provide guidance but the statersquos decision are ultimately made by
them The hospitals donrsquot have the same situation where patients are interacting with each
other so that risk factor for transmission of COVID-19 isnrsquot present Hospital staff still needs to
be screened and vigilant and everyone has to wear surgical masks for source control and
personal protection But the situations of care are different so that is why long term care staff
is being tested on a baseline and not hospital staff is being tested on a baseline
6 Is all cautery in surgery a risk or just cautery when it involves the nasal or laryngeal areas
Not all cautery in surgery is the same risk Abdominal cautery would not carry the same risk as
nasal or laryngeal cautery which involves the respiratory system Nebraska Medicine follows
this same idea where there isnrsquot risk involved in cautery on legs arms etc
7 Have long-term care facilities been advised by ICAP to not allow admissions into their facilities
until no one (employee or patients) tests positive
The only time that a facility is not going to have admission is if they cannot take care of the
patient they are admitting (the CMS rule refers to not having the capacity the staff expertise or
the PPE to care for patients) A facility that does not have a way to cohort any existing COVID-19
positive patients or have room to take more patients safely is the only time we would tell a
facility not to admit patients There is guidance about admitting a COVID positive patients ndash if
they are within the 28-day time period they should have a two-test negative before they are
admitted especially if they are going into a facility that has not had a COVID-19 case before
because they wonrsquot have a red zone in place If a facility has already had a COVID-19 positive
case and have a red zone in place (separated from the rest of the facility and they have room
there for another positive patient) that is fine There are a lot of case-by-case decisions to be
made
8 Is there anything guidance I could share with staff not to double their maskswearing a N-95
with a surgical mask over top There is concern to conserve their PPE if wearing goggles that
this helps but concern about compromising the fit as well as comfort
This is an issue of how much PPE you have during this time of inventory shortages You still
want PPE worn correctly so the staff can be directed on the correct way You probably need to
talk to the staff to find out reasons for their concern in not following the protocol for wearing
PPE ndash concern over not having enough N95 masks to wear etc Those should be addressed
You can let ICAP know if you are short of PPE so we can try to help with acquisition of PPE
reprocessing etc Keep control over inventory so they arenrsquot taking PPE that they donrsquot need
Someone on your staff can work with others on their PPE use In general we donrsquot recommend
wearing a surgical mask over an N95 A face shield is a different strategy that can be used over
an N95 We still want to limit the use of N95 to one shift per mask Nebraska Medicine has
seen the use migrate to using an N95 mask (down from using face shields extra procedure
masks) etc and they have not seen COVID transmission or increased burn rates for N95 masks
9 For Alisha in OR when wearing goggles over a face shield do you just have reprocess after
that wear
No you just need to wipe them with disinfectant wipes once you take them off They are not
reprocessed
Non-operative and Ambulatory Pre-Procedure Testing for COVID-19
Non-operative and Ambulatory Pre-Procedure Testing Guidancebull High-risk aerosol-generating procedures(AGPs) are defined within the
perioperative guidance and includebull surgery anywhere within the upper respiratory tract
bull flexible bronchoscopy
bull Rhinoscopy
bull laryngoscopy (including intubation)
bull GI endoscopy procedures with need for sedation or spinal anesthetic that have a high likelihood of requiring manual (bag valve mask) ventilation or intubation ( such as TEE ECT cardioversion C-section)
bull ENTOMFSDental procedures utilizing cautery laser drill or saw within the airway or oral cavity
httpswwwnebraskamedcomsitesdefaultfilesdocumentscovid-19procedural-guidance-for-low-risk-procedures05112020pdf
When COVID-19 Testing for patients shouldbe donebull COVID19 pre-procedural testing is mandatory for elective procedures
requiring deep sedationanalgesia and anesthesia
bull Patient has any symptoms concerning for COVID19 Symptomatic patients must be evaluated and procedures should be deferred until acute illness has resolved (per other guidance) If COVID19+ will need to defer procedure if possible If urgent COVID19 level precautions should be taken
bull In cases where Infection Control has approved specific guidance unique to a specialty such as Dentistry Interventional Radiology ECT
httpswwwnebraskamedcomsitesdefaultfilesdocumentscovid-19procedural-guidance-for-low-risk-procedures05112020pdf
Perioperative Testing Guidance
bull Complex and multi-factorial
bull Advise looking at all of the resources
httpswwwnebraskamedcomfor-providerscovid19operating-room-procedures
-
httpswwwnebraskamedcomsitesdefaultfilesdocumentscovid-19preprocedural-testing-algorithm-for-covid-positive-patientspdf
Pre-procedure testing
AORN httpswwwaornorgguidelinesaorn-supportroadmap-for-resuming-elective-surgery-after-covid-19
Facilities should use available testing to protect staff and patient safety whenever possible
CHI httpswwwchihealthcomenpatients-visitorscoronavirus-covid-19covid-19-elective-surgery-precautionshtml
ldquoRequiring COVID-19 testing for patients prior to certain procedures to provide appropriate care and to reduce the risk of infection for caregiversrdquo
Frequently Asked Questions
Should we see nursing home patients in our clinics Arenrsquot they really high risk for bringing COVID-19 into the facility
Image Pixabay
Yes
bull Long-term care facilities have had stringent infection control processes since March
bull Recommend use of a procedure mask for the residentbull Plus procedure mask for HCW for non-COVID-19 visits
bull Plus N95 respirator gown gloves eye protection for COVID-19 visits
Is there a tool to help me plan for or quantify a potential surge in COVID-19 cases
Image Pixabay
Yes
Here is a CDC tool for calculating a surge in your community
httpswwwcdcgovcoronavirus2019-ncovhcpCOVIDSurgehtml [cdcgov]
It has been a month since our resident was tested positive and he is
still testing positive although asymptomatic for a week now How
long we should keep testing
Image Pixabay
Do we really need to keep 6 feet of distance between our coworkers in the break room
Yes
bull Maintain at least 6 feet distance from others especially when mask use is not feasible (such as during eating or drinking)
bull Decrease the number of employees in break areasbull Eat in shifts
bull Go outside to eat
bull Open up additional space for breaks
httpswwwcdcgovcoronavirus2019-ncovcommunityguidance-business-responsehtml for additional tips
Monday ndash Friday
730 AM ndash 930 AM Central Time
200 PM -400 PM Central Time
Call 402-552-2881
IP Office Hours
Questions and Answer SessionUse the QA box in the webinar platform to type a question Questions will be read aloud by the moderator
If your question is not answered during the webinar please either e-mail it to NE ICAP or call during our office hours to speak with one of our IPs
A transcript of the discussion will be made available on the ICAP website
Panelists today are
Dr Salman Ashraf salmanashrafunmceduKate Tyner RN BSN CIC ltynernebraskamedcomMargaret Drake MT(ASCP)CIC MargaretDrakeNebraskagovTeri Fitzgerald RN BSN CIC tfitzgeraldnebraskamedcomDr Ishrat Kamal-Ahmed IshratKamal-AhmednebraskagovAlisha Dorn BSN RN CIC adornnebraskamedcom
httpsicapnebraskamedcomcoronavirushttpsicapnebraskamedcomcovid-19-webinars
Questions and Answer Session
Use the QA box in the webinar platform to type a question Questions will be read aloud by the moderator in the order they are received
A transcript of the discussion will be made available on the ICAP website
Moderated by Mounica Soma MHA
httpsicapnebraskamedcomresources
Responses were provided based on information known on 6162020 and may become out of date
Guidance is being updated rapidly so users should look to CDC and NE DHHS guidance for updates
NETEC ndash NICSNebraska DHHS HAI-ARNebraska ICAP Small and Critical Access Hospitals-Outpatient Region VII Webinar on COVID-19 6162020
1 Do you see recommendation for masks or face coverings going away anytime soon
We donrsquot seeing the recommendation changing because we are still seeing community
transmission of COVID-19 As long as there is community transmission the use of masks or face
coverings will be recommended That is especially true because we see spread that is pre-
symptomatic or asymptomatic We expect the universal mask recommendation to continue at
least until an effective vaccine is developed
2 Do you have any guidance for hospitals in making the decision when it is appropriate to relax
visitor restrictions amp stop temperature checks on everyone Am I safe to assume mandatory
mask wear in a hospital setting will continue through this year and into next year
Visitor restrictions are being loosened in some hospitals allowing one visitor per one patient
Nebraska Medicine has not done this yet Decisions on this will depend on which hospital (and
what is going on inside that hospital) plus things like community transmission what region you
are in The issue is that we are seeing community transmission and sometimes transmission is
happening from people who have minimal symptoms they donrsquot feel ill and donrsquot recognize that
they have COVID-19 We are still seeing people identified when they come to our hospitals who
have fevers and donrsquot even realize that when they try to enter I think the temperature checks
will continue for as long as we have universal masking We will probably see loosening of visitor
restrictions as we go forward if the case counts continue to go down Nebraska Medicine has
continued to identity people who have symptoms and temperatures during the screening
process at the entries Another issue Nebraska Medicine has seen in its hospital and clinic
waiting rooms is to be able to adhere to social distancing if you allow each patient to bring along
a visitor With some of the seats marked off to stay empty Nebraska Medicinersquos clinic waiting
rooms are already at capacity just with the patients There are logistical issues when you
increase the number of people coming into the clinics and hospitals That is something you
need to consider in your facilityrsquos planning
3 In regards to eye protection If a person has a prescription safety glasses are those okay for
use Does the eye protection need to be cleaned when going in and out of patient rooms Do
they need to clean after each patient (non-COVID) if glasses didnt visible become soiled
The prescription safety glasses could be allowed if they are OSHA-approved and we knew where
they were acquired For going in and out of patient rooms Nebraska Medicine treats the eye
protection like other extended use PPE The staff member does not touch the eye protection
and if they do then they do remove them and clean them with disinfectant wipes That also
applies if the eye protection becomes visibly soiled they are taken off and disinfected
Otherwise staff is allowed to continue to keep the eye protection on and wear them for an
extended period of time
4 What is the logic for mass testing long-term care staff prior to Phase II What real benefit is a
snap shot in time test result when you are in a situation that staff come and go between
multiple facilities Can go out in the community without restrictions no accountability to
mask andor social distance The reality is you cant control what staff do in the community
We agree that it is important to know that you cannot control what staff does out in the
community but we can educate staff to follow social distancing and masking in the community
Baseline testing does give you an idea what is going on in your facility at the time when you are
considering opening up or relaxing some of the restrictions It gives you a basic idea of your
facility situation If you do a staff testing and that day the entire staff is negative you know your
risk is lower in your facility and you can start reopening with more confidence If you do find a
number of staff positive when you test it is a sign that you may need to wait to relax
restrictions It is also a sign that there could be residents who are COVID-19 positive that you do
not know about who are asymptomatically or pre-symptomatically positive If you were to open
up at that time there may be increased transmission within the home Thatrsquos because when
you go from Phase I to Phase 2 to Phase 3 you would be increasing activities and resident to
resident interaction in the nursing home Staff testing also gives you an idea of what is going on
with the residents because if all the staff are negative chances are that all the residents would
be negative as well The residents are only getting from the staff at this time so if the staff is all
negative it shows they probably are doing the right thing out in the community or that there is
not much COVID-19 in their community right now
5 Since long-term care facilities are being required to test as a baseline will hospital staff also
need to be tested for a baseline
Nursing home residents are a unique population because they are living in a congregate
community Long term care staff are being tested first because it also gives us approximate
measures of what may be going on in the resident population We know that when restrictions
are being lifted the residents will start interacting with each other again and we want to identify
any positive residents before that happens to avoid transmission Those decisions are being
made by the state and we provide guidance but the statersquos decision are ultimately made by
them The hospitals donrsquot have the same situation where patients are interacting with each
other so that risk factor for transmission of COVID-19 isnrsquot present Hospital staff still needs to
be screened and vigilant and everyone has to wear surgical masks for source control and
personal protection But the situations of care are different so that is why long term care staff
is being tested on a baseline and not hospital staff is being tested on a baseline
6 Is all cautery in surgery a risk or just cautery when it involves the nasal or laryngeal areas
Not all cautery in surgery is the same risk Abdominal cautery would not carry the same risk as
nasal or laryngeal cautery which involves the respiratory system Nebraska Medicine follows
this same idea where there isnrsquot risk involved in cautery on legs arms etc
7 Have long-term care facilities been advised by ICAP to not allow admissions into their facilities
until no one (employee or patients) tests positive
The only time that a facility is not going to have admission is if they cannot take care of the
patient they are admitting (the CMS rule refers to not having the capacity the staff expertise or
the PPE to care for patients) A facility that does not have a way to cohort any existing COVID-19
positive patients or have room to take more patients safely is the only time we would tell a
facility not to admit patients There is guidance about admitting a COVID positive patients ndash if
they are within the 28-day time period they should have a two-test negative before they are
admitted especially if they are going into a facility that has not had a COVID-19 case before
because they wonrsquot have a red zone in place If a facility has already had a COVID-19 positive
case and have a red zone in place (separated from the rest of the facility and they have room
there for another positive patient) that is fine There are a lot of case-by-case decisions to be
made
8 Is there anything guidance I could share with staff not to double their maskswearing a N-95
with a surgical mask over top There is concern to conserve their PPE if wearing goggles that
this helps but concern about compromising the fit as well as comfort
This is an issue of how much PPE you have during this time of inventory shortages You still
want PPE worn correctly so the staff can be directed on the correct way You probably need to
talk to the staff to find out reasons for their concern in not following the protocol for wearing
PPE ndash concern over not having enough N95 masks to wear etc Those should be addressed
You can let ICAP know if you are short of PPE so we can try to help with acquisition of PPE
reprocessing etc Keep control over inventory so they arenrsquot taking PPE that they donrsquot need
Someone on your staff can work with others on their PPE use In general we donrsquot recommend
wearing a surgical mask over an N95 A face shield is a different strategy that can be used over
an N95 We still want to limit the use of N95 to one shift per mask Nebraska Medicine has
seen the use migrate to using an N95 mask (down from using face shields extra procedure
masks) etc and they have not seen COVID transmission or increased burn rates for N95 masks
9 For Alisha in OR when wearing goggles over a face shield do you just have reprocess after
that wear
No you just need to wipe them with disinfectant wipes once you take them off They are not
reprocessed
When COVID-19 Testing for patients shouldbe donebull COVID19 pre-procedural testing is mandatory for elective procedures
requiring deep sedationanalgesia and anesthesia
bull Patient has any symptoms concerning for COVID19 Symptomatic patients must be evaluated and procedures should be deferred until acute illness has resolved (per other guidance) If COVID19+ will need to defer procedure if possible If urgent COVID19 level precautions should be taken
bull In cases where Infection Control has approved specific guidance unique to a specialty such as Dentistry Interventional Radiology ECT
httpswwwnebraskamedcomsitesdefaultfilesdocumentscovid-19procedural-guidance-for-low-risk-procedures05112020pdf
Perioperative Testing Guidance
bull Complex and multi-factorial
bull Advise looking at all of the resources
httpswwwnebraskamedcomfor-providerscovid19operating-room-procedures
-
httpswwwnebraskamedcomsitesdefaultfilesdocumentscovid-19preprocedural-testing-algorithm-for-covid-positive-patientspdf
Pre-procedure testing
AORN httpswwwaornorgguidelinesaorn-supportroadmap-for-resuming-elective-surgery-after-covid-19
Facilities should use available testing to protect staff and patient safety whenever possible
CHI httpswwwchihealthcomenpatients-visitorscoronavirus-covid-19covid-19-elective-surgery-precautionshtml
ldquoRequiring COVID-19 testing for patients prior to certain procedures to provide appropriate care and to reduce the risk of infection for caregiversrdquo
Frequently Asked Questions
Should we see nursing home patients in our clinics Arenrsquot they really high risk for bringing COVID-19 into the facility
Image Pixabay
Yes
bull Long-term care facilities have had stringent infection control processes since March
bull Recommend use of a procedure mask for the residentbull Plus procedure mask for HCW for non-COVID-19 visits
bull Plus N95 respirator gown gloves eye protection for COVID-19 visits
Is there a tool to help me plan for or quantify a potential surge in COVID-19 cases
Image Pixabay
Yes
Here is a CDC tool for calculating a surge in your community
httpswwwcdcgovcoronavirus2019-ncovhcpCOVIDSurgehtml [cdcgov]
It has been a month since our resident was tested positive and he is
still testing positive although asymptomatic for a week now How
long we should keep testing
Image Pixabay
Do we really need to keep 6 feet of distance between our coworkers in the break room
Yes
bull Maintain at least 6 feet distance from others especially when mask use is not feasible (such as during eating or drinking)
bull Decrease the number of employees in break areasbull Eat in shifts
bull Go outside to eat
bull Open up additional space for breaks
httpswwwcdcgovcoronavirus2019-ncovcommunityguidance-business-responsehtml for additional tips
Monday ndash Friday
730 AM ndash 930 AM Central Time
200 PM -400 PM Central Time
Call 402-552-2881
IP Office Hours
Questions and Answer SessionUse the QA box in the webinar platform to type a question Questions will be read aloud by the moderator
If your question is not answered during the webinar please either e-mail it to NE ICAP or call during our office hours to speak with one of our IPs
A transcript of the discussion will be made available on the ICAP website
Panelists today are
Dr Salman Ashraf salmanashrafunmceduKate Tyner RN BSN CIC ltynernebraskamedcomMargaret Drake MT(ASCP)CIC MargaretDrakeNebraskagovTeri Fitzgerald RN BSN CIC tfitzgeraldnebraskamedcomDr Ishrat Kamal-Ahmed IshratKamal-AhmednebraskagovAlisha Dorn BSN RN CIC adornnebraskamedcom
httpsicapnebraskamedcomcoronavirushttpsicapnebraskamedcomcovid-19-webinars
Questions and Answer Session
Use the QA box in the webinar platform to type a question Questions will be read aloud by the moderator in the order they are received
A transcript of the discussion will be made available on the ICAP website
Moderated by Mounica Soma MHA
httpsicapnebraskamedcomresources
Responses were provided based on information known on 6162020 and may become out of date
Guidance is being updated rapidly so users should look to CDC and NE DHHS guidance for updates
NETEC ndash NICSNebraska DHHS HAI-ARNebraska ICAP Small and Critical Access Hospitals-Outpatient Region VII Webinar on COVID-19 6162020
1 Do you see recommendation for masks or face coverings going away anytime soon
We donrsquot seeing the recommendation changing because we are still seeing community
transmission of COVID-19 As long as there is community transmission the use of masks or face
coverings will be recommended That is especially true because we see spread that is pre-
symptomatic or asymptomatic We expect the universal mask recommendation to continue at
least until an effective vaccine is developed
2 Do you have any guidance for hospitals in making the decision when it is appropriate to relax
visitor restrictions amp stop temperature checks on everyone Am I safe to assume mandatory
mask wear in a hospital setting will continue through this year and into next year
Visitor restrictions are being loosened in some hospitals allowing one visitor per one patient
Nebraska Medicine has not done this yet Decisions on this will depend on which hospital (and
what is going on inside that hospital) plus things like community transmission what region you
are in The issue is that we are seeing community transmission and sometimes transmission is
happening from people who have minimal symptoms they donrsquot feel ill and donrsquot recognize that
they have COVID-19 We are still seeing people identified when they come to our hospitals who
have fevers and donrsquot even realize that when they try to enter I think the temperature checks
will continue for as long as we have universal masking We will probably see loosening of visitor
restrictions as we go forward if the case counts continue to go down Nebraska Medicine has
continued to identity people who have symptoms and temperatures during the screening
process at the entries Another issue Nebraska Medicine has seen in its hospital and clinic
waiting rooms is to be able to adhere to social distancing if you allow each patient to bring along
a visitor With some of the seats marked off to stay empty Nebraska Medicinersquos clinic waiting
rooms are already at capacity just with the patients There are logistical issues when you
increase the number of people coming into the clinics and hospitals That is something you
need to consider in your facilityrsquos planning
3 In regards to eye protection If a person has a prescription safety glasses are those okay for
use Does the eye protection need to be cleaned when going in and out of patient rooms Do
they need to clean after each patient (non-COVID) if glasses didnt visible become soiled
The prescription safety glasses could be allowed if they are OSHA-approved and we knew where
they were acquired For going in and out of patient rooms Nebraska Medicine treats the eye
protection like other extended use PPE The staff member does not touch the eye protection
and if they do then they do remove them and clean them with disinfectant wipes That also
applies if the eye protection becomes visibly soiled they are taken off and disinfected
Otherwise staff is allowed to continue to keep the eye protection on and wear them for an
extended period of time
4 What is the logic for mass testing long-term care staff prior to Phase II What real benefit is a
snap shot in time test result when you are in a situation that staff come and go between
multiple facilities Can go out in the community without restrictions no accountability to
mask andor social distance The reality is you cant control what staff do in the community
We agree that it is important to know that you cannot control what staff does out in the
community but we can educate staff to follow social distancing and masking in the community
Baseline testing does give you an idea what is going on in your facility at the time when you are
considering opening up or relaxing some of the restrictions It gives you a basic idea of your
facility situation If you do a staff testing and that day the entire staff is negative you know your
risk is lower in your facility and you can start reopening with more confidence If you do find a
number of staff positive when you test it is a sign that you may need to wait to relax
restrictions It is also a sign that there could be residents who are COVID-19 positive that you do
not know about who are asymptomatically or pre-symptomatically positive If you were to open
up at that time there may be increased transmission within the home Thatrsquos because when
you go from Phase I to Phase 2 to Phase 3 you would be increasing activities and resident to
resident interaction in the nursing home Staff testing also gives you an idea of what is going on
with the residents because if all the staff are negative chances are that all the residents would
be negative as well The residents are only getting from the staff at this time so if the staff is all
negative it shows they probably are doing the right thing out in the community or that there is
not much COVID-19 in their community right now
5 Since long-term care facilities are being required to test as a baseline will hospital staff also
need to be tested for a baseline
Nursing home residents are a unique population because they are living in a congregate
community Long term care staff are being tested first because it also gives us approximate
measures of what may be going on in the resident population We know that when restrictions
are being lifted the residents will start interacting with each other again and we want to identify
any positive residents before that happens to avoid transmission Those decisions are being
made by the state and we provide guidance but the statersquos decision are ultimately made by
them The hospitals donrsquot have the same situation where patients are interacting with each
other so that risk factor for transmission of COVID-19 isnrsquot present Hospital staff still needs to
be screened and vigilant and everyone has to wear surgical masks for source control and
personal protection But the situations of care are different so that is why long term care staff
is being tested on a baseline and not hospital staff is being tested on a baseline
6 Is all cautery in surgery a risk or just cautery when it involves the nasal or laryngeal areas
Not all cautery in surgery is the same risk Abdominal cautery would not carry the same risk as
nasal or laryngeal cautery which involves the respiratory system Nebraska Medicine follows
this same idea where there isnrsquot risk involved in cautery on legs arms etc
7 Have long-term care facilities been advised by ICAP to not allow admissions into their facilities
until no one (employee or patients) tests positive
The only time that a facility is not going to have admission is if they cannot take care of the
patient they are admitting (the CMS rule refers to not having the capacity the staff expertise or
the PPE to care for patients) A facility that does not have a way to cohort any existing COVID-19
positive patients or have room to take more patients safely is the only time we would tell a
facility not to admit patients There is guidance about admitting a COVID positive patients ndash if
they are within the 28-day time period they should have a two-test negative before they are
admitted especially if they are going into a facility that has not had a COVID-19 case before
because they wonrsquot have a red zone in place If a facility has already had a COVID-19 positive
case and have a red zone in place (separated from the rest of the facility and they have room
there for another positive patient) that is fine There are a lot of case-by-case decisions to be
made
8 Is there anything guidance I could share with staff not to double their maskswearing a N-95
with a surgical mask over top There is concern to conserve their PPE if wearing goggles that
this helps but concern about compromising the fit as well as comfort
This is an issue of how much PPE you have during this time of inventory shortages You still
want PPE worn correctly so the staff can be directed on the correct way You probably need to
talk to the staff to find out reasons for their concern in not following the protocol for wearing
PPE ndash concern over not having enough N95 masks to wear etc Those should be addressed
You can let ICAP know if you are short of PPE so we can try to help with acquisition of PPE
reprocessing etc Keep control over inventory so they arenrsquot taking PPE that they donrsquot need
Someone on your staff can work with others on their PPE use In general we donrsquot recommend
wearing a surgical mask over an N95 A face shield is a different strategy that can be used over
an N95 We still want to limit the use of N95 to one shift per mask Nebraska Medicine has
seen the use migrate to using an N95 mask (down from using face shields extra procedure
masks) etc and they have not seen COVID transmission or increased burn rates for N95 masks
9 For Alisha in OR when wearing goggles over a face shield do you just have reprocess after
that wear
No you just need to wipe them with disinfectant wipes once you take them off They are not
reprocessed
Perioperative Testing Guidance
bull Complex and multi-factorial
bull Advise looking at all of the resources
httpswwwnebraskamedcomfor-providerscovid19operating-room-procedures
-
httpswwwnebraskamedcomsitesdefaultfilesdocumentscovid-19preprocedural-testing-algorithm-for-covid-positive-patientspdf
Pre-procedure testing
AORN httpswwwaornorgguidelinesaorn-supportroadmap-for-resuming-elective-surgery-after-covid-19
Facilities should use available testing to protect staff and patient safety whenever possible
CHI httpswwwchihealthcomenpatients-visitorscoronavirus-covid-19covid-19-elective-surgery-precautionshtml
ldquoRequiring COVID-19 testing for patients prior to certain procedures to provide appropriate care and to reduce the risk of infection for caregiversrdquo
Frequently Asked Questions
Should we see nursing home patients in our clinics Arenrsquot they really high risk for bringing COVID-19 into the facility
Image Pixabay
Yes
bull Long-term care facilities have had stringent infection control processes since March
bull Recommend use of a procedure mask for the residentbull Plus procedure mask for HCW for non-COVID-19 visits
bull Plus N95 respirator gown gloves eye protection for COVID-19 visits
Is there a tool to help me plan for or quantify a potential surge in COVID-19 cases
Image Pixabay
Yes
Here is a CDC tool for calculating a surge in your community
httpswwwcdcgovcoronavirus2019-ncovhcpCOVIDSurgehtml [cdcgov]
It has been a month since our resident was tested positive and he is
still testing positive although asymptomatic for a week now How
long we should keep testing
Image Pixabay
Do we really need to keep 6 feet of distance between our coworkers in the break room
Yes
bull Maintain at least 6 feet distance from others especially when mask use is not feasible (such as during eating or drinking)
bull Decrease the number of employees in break areasbull Eat in shifts
bull Go outside to eat
bull Open up additional space for breaks
httpswwwcdcgovcoronavirus2019-ncovcommunityguidance-business-responsehtml for additional tips
Monday ndash Friday
730 AM ndash 930 AM Central Time
200 PM -400 PM Central Time
Call 402-552-2881
IP Office Hours
Questions and Answer SessionUse the QA box in the webinar platform to type a question Questions will be read aloud by the moderator
If your question is not answered during the webinar please either e-mail it to NE ICAP or call during our office hours to speak with one of our IPs
A transcript of the discussion will be made available on the ICAP website
Panelists today are
Dr Salman Ashraf salmanashrafunmceduKate Tyner RN BSN CIC ltynernebraskamedcomMargaret Drake MT(ASCP)CIC MargaretDrakeNebraskagovTeri Fitzgerald RN BSN CIC tfitzgeraldnebraskamedcomDr Ishrat Kamal-Ahmed IshratKamal-AhmednebraskagovAlisha Dorn BSN RN CIC adornnebraskamedcom
httpsicapnebraskamedcomcoronavirushttpsicapnebraskamedcomcovid-19-webinars
Questions and Answer Session
Use the QA box in the webinar platform to type a question Questions will be read aloud by the moderator in the order they are received
A transcript of the discussion will be made available on the ICAP website
Moderated by Mounica Soma MHA
httpsicapnebraskamedcomresources
Responses were provided based on information known on 6162020 and may become out of date
Guidance is being updated rapidly so users should look to CDC and NE DHHS guidance for updates
NETEC ndash NICSNebraska DHHS HAI-ARNebraska ICAP Small and Critical Access Hospitals-Outpatient Region VII Webinar on COVID-19 6162020
1 Do you see recommendation for masks or face coverings going away anytime soon
We donrsquot seeing the recommendation changing because we are still seeing community
transmission of COVID-19 As long as there is community transmission the use of masks or face
coverings will be recommended That is especially true because we see spread that is pre-
symptomatic or asymptomatic We expect the universal mask recommendation to continue at
least until an effective vaccine is developed
2 Do you have any guidance for hospitals in making the decision when it is appropriate to relax
visitor restrictions amp stop temperature checks on everyone Am I safe to assume mandatory
mask wear in a hospital setting will continue through this year and into next year
Visitor restrictions are being loosened in some hospitals allowing one visitor per one patient
Nebraska Medicine has not done this yet Decisions on this will depend on which hospital (and
what is going on inside that hospital) plus things like community transmission what region you
are in The issue is that we are seeing community transmission and sometimes transmission is
happening from people who have minimal symptoms they donrsquot feel ill and donrsquot recognize that
they have COVID-19 We are still seeing people identified when they come to our hospitals who
have fevers and donrsquot even realize that when they try to enter I think the temperature checks
will continue for as long as we have universal masking We will probably see loosening of visitor
restrictions as we go forward if the case counts continue to go down Nebraska Medicine has
continued to identity people who have symptoms and temperatures during the screening
process at the entries Another issue Nebraska Medicine has seen in its hospital and clinic
waiting rooms is to be able to adhere to social distancing if you allow each patient to bring along
a visitor With some of the seats marked off to stay empty Nebraska Medicinersquos clinic waiting
rooms are already at capacity just with the patients There are logistical issues when you
increase the number of people coming into the clinics and hospitals That is something you
need to consider in your facilityrsquos planning
3 In regards to eye protection If a person has a prescription safety glasses are those okay for
use Does the eye protection need to be cleaned when going in and out of patient rooms Do
they need to clean after each patient (non-COVID) if glasses didnt visible become soiled
The prescription safety glasses could be allowed if they are OSHA-approved and we knew where
they were acquired For going in and out of patient rooms Nebraska Medicine treats the eye
protection like other extended use PPE The staff member does not touch the eye protection
and if they do then they do remove them and clean them with disinfectant wipes That also
applies if the eye protection becomes visibly soiled they are taken off and disinfected
Otherwise staff is allowed to continue to keep the eye protection on and wear them for an
extended period of time
4 What is the logic for mass testing long-term care staff prior to Phase II What real benefit is a
snap shot in time test result when you are in a situation that staff come and go between
multiple facilities Can go out in the community without restrictions no accountability to
mask andor social distance The reality is you cant control what staff do in the community
We agree that it is important to know that you cannot control what staff does out in the
community but we can educate staff to follow social distancing and masking in the community
Baseline testing does give you an idea what is going on in your facility at the time when you are
considering opening up or relaxing some of the restrictions It gives you a basic idea of your
facility situation If you do a staff testing and that day the entire staff is negative you know your
risk is lower in your facility and you can start reopening with more confidence If you do find a
number of staff positive when you test it is a sign that you may need to wait to relax
restrictions It is also a sign that there could be residents who are COVID-19 positive that you do
not know about who are asymptomatically or pre-symptomatically positive If you were to open
up at that time there may be increased transmission within the home Thatrsquos because when
you go from Phase I to Phase 2 to Phase 3 you would be increasing activities and resident to
resident interaction in the nursing home Staff testing also gives you an idea of what is going on
with the residents because if all the staff are negative chances are that all the residents would
be negative as well The residents are only getting from the staff at this time so if the staff is all
negative it shows they probably are doing the right thing out in the community or that there is
not much COVID-19 in their community right now
5 Since long-term care facilities are being required to test as a baseline will hospital staff also
need to be tested for a baseline
Nursing home residents are a unique population because they are living in a congregate
community Long term care staff are being tested first because it also gives us approximate
measures of what may be going on in the resident population We know that when restrictions
are being lifted the residents will start interacting with each other again and we want to identify
any positive residents before that happens to avoid transmission Those decisions are being
made by the state and we provide guidance but the statersquos decision are ultimately made by
them The hospitals donrsquot have the same situation where patients are interacting with each
other so that risk factor for transmission of COVID-19 isnrsquot present Hospital staff still needs to
be screened and vigilant and everyone has to wear surgical masks for source control and
personal protection But the situations of care are different so that is why long term care staff
is being tested on a baseline and not hospital staff is being tested on a baseline
6 Is all cautery in surgery a risk or just cautery when it involves the nasal or laryngeal areas
Not all cautery in surgery is the same risk Abdominal cautery would not carry the same risk as
nasal or laryngeal cautery which involves the respiratory system Nebraska Medicine follows
this same idea where there isnrsquot risk involved in cautery on legs arms etc
7 Have long-term care facilities been advised by ICAP to not allow admissions into their facilities
until no one (employee or patients) tests positive
The only time that a facility is not going to have admission is if they cannot take care of the
patient they are admitting (the CMS rule refers to not having the capacity the staff expertise or
the PPE to care for patients) A facility that does not have a way to cohort any existing COVID-19
positive patients or have room to take more patients safely is the only time we would tell a
facility not to admit patients There is guidance about admitting a COVID positive patients ndash if
they are within the 28-day time period they should have a two-test negative before they are
admitted especially if they are going into a facility that has not had a COVID-19 case before
because they wonrsquot have a red zone in place If a facility has already had a COVID-19 positive
case and have a red zone in place (separated from the rest of the facility and they have room
there for another positive patient) that is fine There are a lot of case-by-case decisions to be
made
8 Is there anything guidance I could share with staff not to double their maskswearing a N-95
with a surgical mask over top There is concern to conserve their PPE if wearing goggles that
this helps but concern about compromising the fit as well as comfort
This is an issue of how much PPE you have during this time of inventory shortages You still
want PPE worn correctly so the staff can be directed on the correct way You probably need to
talk to the staff to find out reasons for their concern in not following the protocol for wearing
PPE ndash concern over not having enough N95 masks to wear etc Those should be addressed
You can let ICAP know if you are short of PPE so we can try to help with acquisition of PPE
reprocessing etc Keep control over inventory so they arenrsquot taking PPE that they donrsquot need
Someone on your staff can work with others on their PPE use In general we donrsquot recommend
wearing a surgical mask over an N95 A face shield is a different strategy that can be used over
an N95 We still want to limit the use of N95 to one shift per mask Nebraska Medicine has
seen the use migrate to using an N95 mask (down from using face shields extra procedure
masks) etc and they have not seen COVID transmission or increased burn rates for N95 masks
9 For Alisha in OR when wearing goggles over a face shield do you just have reprocess after
that wear
No you just need to wipe them with disinfectant wipes once you take them off They are not
reprocessed
-
httpswwwnebraskamedcomsitesdefaultfilesdocumentscovid-19preprocedural-testing-algorithm-for-covid-positive-patientspdf
Pre-procedure testing
AORN httpswwwaornorgguidelinesaorn-supportroadmap-for-resuming-elective-surgery-after-covid-19
Facilities should use available testing to protect staff and patient safety whenever possible
CHI httpswwwchihealthcomenpatients-visitorscoronavirus-covid-19covid-19-elective-surgery-precautionshtml
ldquoRequiring COVID-19 testing for patients prior to certain procedures to provide appropriate care and to reduce the risk of infection for caregiversrdquo
Frequently Asked Questions
Should we see nursing home patients in our clinics Arenrsquot they really high risk for bringing COVID-19 into the facility
Image Pixabay
Yes
bull Long-term care facilities have had stringent infection control processes since March
bull Recommend use of a procedure mask for the residentbull Plus procedure mask for HCW for non-COVID-19 visits
bull Plus N95 respirator gown gloves eye protection for COVID-19 visits
Is there a tool to help me plan for or quantify a potential surge in COVID-19 cases
Image Pixabay
Yes
Here is a CDC tool for calculating a surge in your community
httpswwwcdcgovcoronavirus2019-ncovhcpCOVIDSurgehtml [cdcgov]
It has been a month since our resident was tested positive and he is
still testing positive although asymptomatic for a week now How
long we should keep testing
Image Pixabay
Do we really need to keep 6 feet of distance between our coworkers in the break room
Yes
bull Maintain at least 6 feet distance from others especially when mask use is not feasible (such as during eating or drinking)
bull Decrease the number of employees in break areasbull Eat in shifts
bull Go outside to eat
bull Open up additional space for breaks
httpswwwcdcgovcoronavirus2019-ncovcommunityguidance-business-responsehtml for additional tips
Monday ndash Friday
730 AM ndash 930 AM Central Time
200 PM -400 PM Central Time
Call 402-552-2881
IP Office Hours
Questions and Answer SessionUse the QA box in the webinar platform to type a question Questions will be read aloud by the moderator
If your question is not answered during the webinar please either e-mail it to NE ICAP or call during our office hours to speak with one of our IPs
A transcript of the discussion will be made available on the ICAP website
Panelists today are
Dr Salman Ashraf salmanashrafunmceduKate Tyner RN BSN CIC ltynernebraskamedcomMargaret Drake MT(ASCP)CIC MargaretDrakeNebraskagovTeri Fitzgerald RN BSN CIC tfitzgeraldnebraskamedcomDr Ishrat Kamal-Ahmed IshratKamal-AhmednebraskagovAlisha Dorn BSN RN CIC adornnebraskamedcom
httpsicapnebraskamedcomcoronavirushttpsicapnebraskamedcomcovid-19-webinars
Questions and Answer Session
Use the QA box in the webinar platform to type a question Questions will be read aloud by the moderator in the order they are received
A transcript of the discussion will be made available on the ICAP website
Moderated by Mounica Soma MHA
httpsicapnebraskamedcomresources
Responses were provided based on information known on 6162020 and may become out of date
Guidance is being updated rapidly so users should look to CDC and NE DHHS guidance for updates
NETEC ndash NICSNebraska DHHS HAI-ARNebraska ICAP Small and Critical Access Hospitals-Outpatient Region VII Webinar on COVID-19 6162020
1 Do you see recommendation for masks or face coverings going away anytime soon
We donrsquot seeing the recommendation changing because we are still seeing community
transmission of COVID-19 As long as there is community transmission the use of masks or face
coverings will be recommended That is especially true because we see spread that is pre-
symptomatic or asymptomatic We expect the universal mask recommendation to continue at
least until an effective vaccine is developed
2 Do you have any guidance for hospitals in making the decision when it is appropriate to relax
visitor restrictions amp stop temperature checks on everyone Am I safe to assume mandatory
mask wear in a hospital setting will continue through this year and into next year
Visitor restrictions are being loosened in some hospitals allowing one visitor per one patient
Nebraska Medicine has not done this yet Decisions on this will depend on which hospital (and
what is going on inside that hospital) plus things like community transmission what region you
are in The issue is that we are seeing community transmission and sometimes transmission is
happening from people who have minimal symptoms they donrsquot feel ill and donrsquot recognize that
they have COVID-19 We are still seeing people identified when they come to our hospitals who
have fevers and donrsquot even realize that when they try to enter I think the temperature checks
will continue for as long as we have universal masking We will probably see loosening of visitor
restrictions as we go forward if the case counts continue to go down Nebraska Medicine has
continued to identity people who have symptoms and temperatures during the screening
process at the entries Another issue Nebraska Medicine has seen in its hospital and clinic
waiting rooms is to be able to adhere to social distancing if you allow each patient to bring along
a visitor With some of the seats marked off to stay empty Nebraska Medicinersquos clinic waiting
rooms are already at capacity just with the patients There are logistical issues when you
increase the number of people coming into the clinics and hospitals That is something you
need to consider in your facilityrsquos planning
3 In regards to eye protection If a person has a prescription safety glasses are those okay for
use Does the eye protection need to be cleaned when going in and out of patient rooms Do
they need to clean after each patient (non-COVID) if glasses didnt visible become soiled
The prescription safety glasses could be allowed if they are OSHA-approved and we knew where
they were acquired For going in and out of patient rooms Nebraska Medicine treats the eye
protection like other extended use PPE The staff member does not touch the eye protection
and if they do then they do remove them and clean them with disinfectant wipes That also
applies if the eye protection becomes visibly soiled they are taken off and disinfected
Otherwise staff is allowed to continue to keep the eye protection on and wear them for an
extended period of time
4 What is the logic for mass testing long-term care staff prior to Phase II What real benefit is a
snap shot in time test result when you are in a situation that staff come and go between
multiple facilities Can go out in the community without restrictions no accountability to
mask andor social distance The reality is you cant control what staff do in the community
We agree that it is important to know that you cannot control what staff does out in the
community but we can educate staff to follow social distancing and masking in the community
Baseline testing does give you an idea what is going on in your facility at the time when you are
considering opening up or relaxing some of the restrictions It gives you a basic idea of your
facility situation If you do a staff testing and that day the entire staff is negative you know your
risk is lower in your facility and you can start reopening with more confidence If you do find a
number of staff positive when you test it is a sign that you may need to wait to relax
restrictions It is also a sign that there could be residents who are COVID-19 positive that you do
not know about who are asymptomatically or pre-symptomatically positive If you were to open
up at that time there may be increased transmission within the home Thatrsquos because when
you go from Phase I to Phase 2 to Phase 3 you would be increasing activities and resident to
resident interaction in the nursing home Staff testing also gives you an idea of what is going on
with the residents because if all the staff are negative chances are that all the residents would
be negative as well The residents are only getting from the staff at this time so if the staff is all
negative it shows they probably are doing the right thing out in the community or that there is
not much COVID-19 in their community right now
5 Since long-term care facilities are being required to test as a baseline will hospital staff also
need to be tested for a baseline
Nursing home residents are a unique population because they are living in a congregate
community Long term care staff are being tested first because it also gives us approximate
measures of what may be going on in the resident population We know that when restrictions
are being lifted the residents will start interacting with each other again and we want to identify
any positive residents before that happens to avoid transmission Those decisions are being
made by the state and we provide guidance but the statersquos decision are ultimately made by
them The hospitals donrsquot have the same situation where patients are interacting with each
other so that risk factor for transmission of COVID-19 isnrsquot present Hospital staff still needs to
be screened and vigilant and everyone has to wear surgical masks for source control and
personal protection But the situations of care are different so that is why long term care staff
is being tested on a baseline and not hospital staff is being tested on a baseline
6 Is all cautery in surgery a risk or just cautery when it involves the nasal or laryngeal areas
Not all cautery in surgery is the same risk Abdominal cautery would not carry the same risk as
nasal or laryngeal cautery which involves the respiratory system Nebraska Medicine follows
this same idea where there isnrsquot risk involved in cautery on legs arms etc
7 Have long-term care facilities been advised by ICAP to not allow admissions into their facilities
until no one (employee or patients) tests positive
The only time that a facility is not going to have admission is if they cannot take care of the
patient they are admitting (the CMS rule refers to not having the capacity the staff expertise or
the PPE to care for patients) A facility that does not have a way to cohort any existing COVID-19
positive patients or have room to take more patients safely is the only time we would tell a
facility not to admit patients There is guidance about admitting a COVID positive patients ndash if
they are within the 28-day time period they should have a two-test negative before they are
admitted especially if they are going into a facility that has not had a COVID-19 case before
because they wonrsquot have a red zone in place If a facility has already had a COVID-19 positive
case and have a red zone in place (separated from the rest of the facility and they have room
there for another positive patient) that is fine There are a lot of case-by-case decisions to be
made
8 Is there anything guidance I could share with staff not to double their maskswearing a N-95
with a surgical mask over top There is concern to conserve their PPE if wearing goggles that
this helps but concern about compromising the fit as well as comfort
This is an issue of how much PPE you have during this time of inventory shortages You still
want PPE worn correctly so the staff can be directed on the correct way You probably need to
talk to the staff to find out reasons for their concern in not following the protocol for wearing
PPE ndash concern over not having enough N95 masks to wear etc Those should be addressed
You can let ICAP know if you are short of PPE so we can try to help with acquisition of PPE
reprocessing etc Keep control over inventory so they arenrsquot taking PPE that they donrsquot need
Someone on your staff can work with others on their PPE use In general we donrsquot recommend
wearing a surgical mask over an N95 A face shield is a different strategy that can be used over
an N95 We still want to limit the use of N95 to one shift per mask Nebraska Medicine has
seen the use migrate to using an N95 mask (down from using face shields extra procedure
masks) etc and they have not seen COVID transmission or increased burn rates for N95 masks
9 For Alisha in OR when wearing goggles over a face shield do you just have reprocess after
that wear
No you just need to wipe them with disinfectant wipes once you take them off They are not
reprocessed
Pre-procedure testing
AORN httpswwwaornorgguidelinesaorn-supportroadmap-for-resuming-elective-surgery-after-covid-19
Facilities should use available testing to protect staff and patient safety whenever possible
CHI httpswwwchihealthcomenpatients-visitorscoronavirus-covid-19covid-19-elective-surgery-precautionshtml
ldquoRequiring COVID-19 testing for patients prior to certain procedures to provide appropriate care and to reduce the risk of infection for caregiversrdquo
Frequently Asked Questions
Should we see nursing home patients in our clinics Arenrsquot they really high risk for bringing COVID-19 into the facility
Image Pixabay
Yes
bull Long-term care facilities have had stringent infection control processes since March
bull Recommend use of a procedure mask for the residentbull Plus procedure mask for HCW for non-COVID-19 visits
bull Plus N95 respirator gown gloves eye protection for COVID-19 visits
Is there a tool to help me plan for or quantify a potential surge in COVID-19 cases
Image Pixabay
Yes
Here is a CDC tool for calculating a surge in your community
httpswwwcdcgovcoronavirus2019-ncovhcpCOVIDSurgehtml [cdcgov]
It has been a month since our resident was tested positive and he is
still testing positive although asymptomatic for a week now How
long we should keep testing
Image Pixabay
Do we really need to keep 6 feet of distance between our coworkers in the break room
Yes
bull Maintain at least 6 feet distance from others especially when mask use is not feasible (such as during eating or drinking)
bull Decrease the number of employees in break areasbull Eat in shifts
bull Go outside to eat
bull Open up additional space for breaks
httpswwwcdcgovcoronavirus2019-ncovcommunityguidance-business-responsehtml for additional tips
Monday ndash Friday
730 AM ndash 930 AM Central Time
200 PM -400 PM Central Time
Call 402-552-2881
IP Office Hours
Questions and Answer SessionUse the QA box in the webinar platform to type a question Questions will be read aloud by the moderator
If your question is not answered during the webinar please either e-mail it to NE ICAP or call during our office hours to speak with one of our IPs
A transcript of the discussion will be made available on the ICAP website
Panelists today are
Dr Salman Ashraf salmanashrafunmceduKate Tyner RN BSN CIC ltynernebraskamedcomMargaret Drake MT(ASCP)CIC MargaretDrakeNebraskagovTeri Fitzgerald RN BSN CIC tfitzgeraldnebraskamedcomDr Ishrat Kamal-Ahmed IshratKamal-AhmednebraskagovAlisha Dorn BSN RN CIC adornnebraskamedcom
httpsicapnebraskamedcomcoronavirushttpsicapnebraskamedcomcovid-19-webinars
Questions and Answer Session
Use the QA box in the webinar platform to type a question Questions will be read aloud by the moderator in the order they are received
A transcript of the discussion will be made available on the ICAP website
Moderated by Mounica Soma MHA
httpsicapnebraskamedcomresources
Responses were provided based on information known on 6162020 and may become out of date
Guidance is being updated rapidly so users should look to CDC and NE DHHS guidance for updates
NETEC ndash NICSNebraska DHHS HAI-ARNebraska ICAP Small and Critical Access Hospitals-Outpatient Region VII Webinar on COVID-19 6162020
1 Do you see recommendation for masks or face coverings going away anytime soon
We donrsquot seeing the recommendation changing because we are still seeing community
transmission of COVID-19 As long as there is community transmission the use of masks or face
coverings will be recommended That is especially true because we see spread that is pre-
symptomatic or asymptomatic We expect the universal mask recommendation to continue at
least until an effective vaccine is developed
2 Do you have any guidance for hospitals in making the decision when it is appropriate to relax
visitor restrictions amp stop temperature checks on everyone Am I safe to assume mandatory
mask wear in a hospital setting will continue through this year and into next year
Visitor restrictions are being loosened in some hospitals allowing one visitor per one patient
Nebraska Medicine has not done this yet Decisions on this will depend on which hospital (and
what is going on inside that hospital) plus things like community transmission what region you
are in The issue is that we are seeing community transmission and sometimes transmission is
happening from people who have minimal symptoms they donrsquot feel ill and donrsquot recognize that
they have COVID-19 We are still seeing people identified when they come to our hospitals who
have fevers and donrsquot even realize that when they try to enter I think the temperature checks
will continue for as long as we have universal masking We will probably see loosening of visitor
restrictions as we go forward if the case counts continue to go down Nebraska Medicine has
continued to identity people who have symptoms and temperatures during the screening
process at the entries Another issue Nebraska Medicine has seen in its hospital and clinic
waiting rooms is to be able to adhere to social distancing if you allow each patient to bring along
a visitor With some of the seats marked off to stay empty Nebraska Medicinersquos clinic waiting
rooms are already at capacity just with the patients There are logistical issues when you
increase the number of people coming into the clinics and hospitals That is something you
need to consider in your facilityrsquos planning
3 In regards to eye protection If a person has a prescription safety glasses are those okay for
use Does the eye protection need to be cleaned when going in and out of patient rooms Do
they need to clean after each patient (non-COVID) if glasses didnt visible become soiled
The prescription safety glasses could be allowed if they are OSHA-approved and we knew where
they were acquired For going in and out of patient rooms Nebraska Medicine treats the eye
protection like other extended use PPE The staff member does not touch the eye protection
and if they do then they do remove them and clean them with disinfectant wipes That also
applies if the eye protection becomes visibly soiled they are taken off and disinfected
Otherwise staff is allowed to continue to keep the eye protection on and wear them for an
extended period of time
4 What is the logic for mass testing long-term care staff prior to Phase II What real benefit is a
snap shot in time test result when you are in a situation that staff come and go between
multiple facilities Can go out in the community without restrictions no accountability to
mask andor social distance The reality is you cant control what staff do in the community
We agree that it is important to know that you cannot control what staff does out in the
community but we can educate staff to follow social distancing and masking in the community
Baseline testing does give you an idea what is going on in your facility at the time when you are
considering opening up or relaxing some of the restrictions It gives you a basic idea of your
facility situation If you do a staff testing and that day the entire staff is negative you know your
risk is lower in your facility and you can start reopening with more confidence If you do find a
number of staff positive when you test it is a sign that you may need to wait to relax
restrictions It is also a sign that there could be residents who are COVID-19 positive that you do
not know about who are asymptomatically or pre-symptomatically positive If you were to open
up at that time there may be increased transmission within the home Thatrsquos because when
you go from Phase I to Phase 2 to Phase 3 you would be increasing activities and resident to
resident interaction in the nursing home Staff testing also gives you an idea of what is going on
with the residents because if all the staff are negative chances are that all the residents would
be negative as well The residents are only getting from the staff at this time so if the staff is all
negative it shows they probably are doing the right thing out in the community or that there is
not much COVID-19 in their community right now
5 Since long-term care facilities are being required to test as a baseline will hospital staff also
need to be tested for a baseline
Nursing home residents are a unique population because they are living in a congregate
community Long term care staff are being tested first because it also gives us approximate
measures of what may be going on in the resident population We know that when restrictions
are being lifted the residents will start interacting with each other again and we want to identify
any positive residents before that happens to avoid transmission Those decisions are being
made by the state and we provide guidance but the statersquos decision are ultimately made by
them The hospitals donrsquot have the same situation where patients are interacting with each
other so that risk factor for transmission of COVID-19 isnrsquot present Hospital staff still needs to
be screened and vigilant and everyone has to wear surgical masks for source control and
personal protection But the situations of care are different so that is why long term care staff
is being tested on a baseline and not hospital staff is being tested on a baseline
6 Is all cautery in surgery a risk or just cautery when it involves the nasal or laryngeal areas
Not all cautery in surgery is the same risk Abdominal cautery would not carry the same risk as
nasal or laryngeal cautery which involves the respiratory system Nebraska Medicine follows
this same idea where there isnrsquot risk involved in cautery on legs arms etc
7 Have long-term care facilities been advised by ICAP to not allow admissions into their facilities
until no one (employee or patients) tests positive
The only time that a facility is not going to have admission is if they cannot take care of the
patient they are admitting (the CMS rule refers to not having the capacity the staff expertise or
the PPE to care for patients) A facility that does not have a way to cohort any existing COVID-19
positive patients or have room to take more patients safely is the only time we would tell a
facility not to admit patients There is guidance about admitting a COVID positive patients ndash if
they are within the 28-day time period they should have a two-test negative before they are
admitted especially if they are going into a facility that has not had a COVID-19 case before
because they wonrsquot have a red zone in place If a facility has already had a COVID-19 positive
case and have a red zone in place (separated from the rest of the facility and they have room
there for another positive patient) that is fine There are a lot of case-by-case decisions to be
made
8 Is there anything guidance I could share with staff not to double their maskswearing a N-95
with a surgical mask over top There is concern to conserve their PPE if wearing goggles that
this helps but concern about compromising the fit as well as comfort
This is an issue of how much PPE you have during this time of inventory shortages You still
want PPE worn correctly so the staff can be directed on the correct way You probably need to
talk to the staff to find out reasons for their concern in not following the protocol for wearing
PPE ndash concern over not having enough N95 masks to wear etc Those should be addressed
You can let ICAP know if you are short of PPE so we can try to help with acquisition of PPE
reprocessing etc Keep control over inventory so they arenrsquot taking PPE that they donrsquot need
Someone on your staff can work with others on their PPE use In general we donrsquot recommend
wearing a surgical mask over an N95 A face shield is a different strategy that can be used over
an N95 We still want to limit the use of N95 to one shift per mask Nebraska Medicine has
seen the use migrate to using an N95 mask (down from using face shields extra procedure
masks) etc and they have not seen COVID transmission or increased burn rates for N95 masks
9 For Alisha in OR when wearing goggles over a face shield do you just have reprocess after
that wear
No you just need to wipe them with disinfectant wipes once you take them off They are not
reprocessed
Frequently Asked Questions
Should we see nursing home patients in our clinics Arenrsquot they really high risk for bringing COVID-19 into the facility
Image Pixabay
Yes
bull Long-term care facilities have had stringent infection control processes since March
bull Recommend use of a procedure mask for the residentbull Plus procedure mask for HCW for non-COVID-19 visits
bull Plus N95 respirator gown gloves eye protection for COVID-19 visits
Is there a tool to help me plan for or quantify a potential surge in COVID-19 cases
Image Pixabay
Yes
Here is a CDC tool for calculating a surge in your community
httpswwwcdcgovcoronavirus2019-ncovhcpCOVIDSurgehtml [cdcgov]
It has been a month since our resident was tested positive and he is
still testing positive although asymptomatic for a week now How
long we should keep testing
Image Pixabay
Do we really need to keep 6 feet of distance between our coworkers in the break room
Yes
bull Maintain at least 6 feet distance from others especially when mask use is not feasible (such as during eating or drinking)
bull Decrease the number of employees in break areasbull Eat in shifts
bull Go outside to eat
bull Open up additional space for breaks
httpswwwcdcgovcoronavirus2019-ncovcommunityguidance-business-responsehtml for additional tips
Monday ndash Friday
730 AM ndash 930 AM Central Time
200 PM -400 PM Central Time
Call 402-552-2881
IP Office Hours
Questions and Answer SessionUse the QA box in the webinar platform to type a question Questions will be read aloud by the moderator
If your question is not answered during the webinar please either e-mail it to NE ICAP or call during our office hours to speak with one of our IPs
A transcript of the discussion will be made available on the ICAP website
Panelists today are
Dr Salman Ashraf salmanashrafunmceduKate Tyner RN BSN CIC ltynernebraskamedcomMargaret Drake MT(ASCP)CIC MargaretDrakeNebraskagovTeri Fitzgerald RN BSN CIC tfitzgeraldnebraskamedcomDr Ishrat Kamal-Ahmed IshratKamal-AhmednebraskagovAlisha Dorn BSN RN CIC adornnebraskamedcom
httpsicapnebraskamedcomcoronavirushttpsicapnebraskamedcomcovid-19-webinars
Questions and Answer Session
Use the QA box in the webinar platform to type a question Questions will be read aloud by the moderator in the order they are received
A transcript of the discussion will be made available on the ICAP website
Moderated by Mounica Soma MHA
httpsicapnebraskamedcomresources
Responses were provided based on information known on 6162020 and may become out of date
Guidance is being updated rapidly so users should look to CDC and NE DHHS guidance for updates
NETEC ndash NICSNebraska DHHS HAI-ARNebraska ICAP Small and Critical Access Hospitals-Outpatient Region VII Webinar on COVID-19 6162020
1 Do you see recommendation for masks or face coverings going away anytime soon
We donrsquot seeing the recommendation changing because we are still seeing community
transmission of COVID-19 As long as there is community transmission the use of masks or face
coverings will be recommended That is especially true because we see spread that is pre-
symptomatic or asymptomatic We expect the universal mask recommendation to continue at
least until an effective vaccine is developed
2 Do you have any guidance for hospitals in making the decision when it is appropriate to relax
visitor restrictions amp stop temperature checks on everyone Am I safe to assume mandatory
mask wear in a hospital setting will continue through this year and into next year
Visitor restrictions are being loosened in some hospitals allowing one visitor per one patient
Nebraska Medicine has not done this yet Decisions on this will depend on which hospital (and
what is going on inside that hospital) plus things like community transmission what region you
are in The issue is that we are seeing community transmission and sometimes transmission is
happening from people who have minimal symptoms they donrsquot feel ill and donrsquot recognize that
they have COVID-19 We are still seeing people identified when they come to our hospitals who
have fevers and donrsquot even realize that when they try to enter I think the temperature checks
will continue for as long as we have universal masking We will probably see loosening of visitor
restrictions as we go forward if the case counts continue to go down Nebraska Medicine has
continued to identity people who have symptoms and temperatures during the screening
process at the entries Another issue Nebraska Medicine has seen in its hospital and clinic
waiting rooms is to be able to adhere to social distancing if you allow each patient to bring along
a visitor With some of the seats marked off to stay empty Nebraska Medicinersquos clinic waiting
rooms are already at capacity just with the patients There are logistical issues when you
increase the number of people coming into the clinics and hospitals That is something you
need to consider in your facilityrsquos planning
3 In regards to eye protection If a person has a prescription safety glasses are those okay for
use Does the eye protection need to be cleaned when going in and out of patient rooms Do
they need to clean after each patient (non-COVID) if glasses didnt visible become soiled
The prescription safety glasses could be allowed if they are OSHA-approved and we knew where
they were acquired For going in and out of patient rooms Nebraska Medicine treats the eye
protection like other extended use PPE The staff member does not touch the eye protection
and if they do then they do remove them and clean them with disinfectant wipes That also
applies if the eye protection becomes visibly soiled they are taken off and disinfected
Otherwise staff is allowed to continue to keep the eye protection on and wear them for an
extended period of time
4 What is the logic for mass testing long-term care staff prior to Phase II What real benefit is a
snap shot in time test result when you are in a situation that staff come and go between
multiple facilities Can go out in the community without restrictions no accountability to
mask andor social distance The reality is you cant control what staff do in the community
We agree that it is important to know that you cannot control what staff does out in the
community but we can educate staff to follow social distancing and masking in the community
Baseline testing does give you an idea what is going on in your facility at the time when you are
considering opening up or relaxing some of the restrictions It gives you a basic idea of your
facility situation If you do a staff testing and that day the entire staff is negative you know your
risk is lower in your facility and you can start reopening with more confidence If you do find a
number of staff positive when you test it is a sign that you may need to wait to relax
restrictions It is also a sign that there could be residents who are COVID-19 positive that you do
not know about who are asymptomatically or pre-symptomatically positive If you were to open
up at that time there may be increased transmission within the home Thatrsquos because when
you go from Phase I to Phase 2 to Phase 3 you would be increasing activities and resident to
resident interaction in the nursing home Staff testing also gives you an idea of what is going on
with the residents because if all the staff are negative chances are that all the residents would
be negative as well The residents are only getting from the staff at this time so if the staff is all
negative it shows they probably are doing the right thing out in the community or that there is
not much COVID-19 in their community right now
5 Since long-term care facilities are being required to test as a baseline will hospital staff also
need to be tested for a baseline
Nursing home residents are a unique population because they are living in a congregate
community Long term care staff are being tested first because it also gives us approximate
measures of what may be going on in the resident population We know that when restrictions
are being lifted the residents will start interacting with each other again and we want to identify
any positive residents before that happens to avoid transmission Those decisions are being
made by the state and we provide guidance but the statersquos decision are ultimately made by
them The hospitals donrsquot have the same situation where patients are interacting with each
other so that risk factor for transmission of COVID-19 isnrsquot present Hospital staff still needs to
be screened and vigilant and everyone has to wear surgical masks for source control and
personal protection But the situations of care are different so that is why long term care staff
is being tested on a baseline and not hospital staff is being tested on a baseline
6 Is all cautery in surgery a risk or just cautery when it involves the nasal or laryngeal areas
Not all cautery in surgery is the same risk Abdominal cautery would not carry the same risk as
nasal or laryngeal cautery which involves the respiratory system Nebraska Medicine follows
this same idea where there isnrsquot risk involved in cautery on legs arms etc
7 Have long-term care facilities been advised by ICAP to not allow admissions into their facilities
until no one (employee or patients) tests positive
The only time that a facility is not going to have admission is if they cannot take care of the
patient they are admitting (the CMS rule refers to not having the capacity the staff expertise or
the PPE to care for patients) A facility that does not have a way to cohort any existing COVID-19
positive patients or have room to take more patients safely is the only time we would tell a
facility not to admit patients There is guidance about admitting a COVID positive patients ndash if
they are within the 28-day time period they should have a two-test negative before they are
admitted especially if they are going into a facility that has not had a COVID-19 case before
because they wonrsquot have a red zone in place If a facility has already had a COVID-19 positive
case and have a red zone in place (separated from the rest of the facility and they have room
there for another positive patient) that is fine There are a lot of case-by-case decisions to be
made
8 Is there anything guidance I could share with staff not to double their maskswearing a N-95
with a surgical mask over top There is concern to conserve their PPE if wearing goggles that
this helps but concern about compromising the fit as well as comfort
This is an issue of how much PPE you have during this time of inventory shortages You still
want PPE worn correctly so the staff can be directed on the correct way You probably need to
talk to the staff to find out reasons for their concern in not following the protocol for wearing
PPE ndash concern over not having enough N95 masks to wear etc Those should be addressed
You can let ICAP know if you are short of PPE so we can try to help with acquisition of PPE
reprocessing etc Keep control over inventory so they arenrsquot taking PPE that they donrsquot need
Someone on your staff can work with others on their PPE use In general we donrsquot recommend
wearing a surgical mask over an N95 A face shield is a different strategy that can be used over
an N95 We still want to limit the use of N95 to one shift per mask Nebraska Medicine has
seen the use migrate to using an N95 mask (down from using face shields extra procedure
masks) etc and they have not seen COVID transmission or increased burn rates for N95 masks
9 For Alisha in OR when wearing goggles over a face shield do you just have reprocess after
that wear
No you just need to wipe them with disinfectant wipes once you take them off They are not
reprocessed
Should we see nursing home patients in our clinics Arenrsquot they really high risk for bringing COVID-19 into the facility
Image Pixabay
Yes
bull Long-term care facilities have had stringent infection control processes since March
bull Recommend use of a procedure mask for the residentbull Plus procedure mask for HCW for non-COVID-19 visits
bull Plus N95 respirator gown gloves eye protection for COVID-19 visits
Is there a tool to help me plan for or quantify a potential surge in COVID-19 cases
Image Pixabay
Yes
Here is a CDC tool for calculating a surge in your community
httpswwwcdcgovcoronavirus2019-ncovhcpCOVIDSurgehtml [cdcgov]
It has been a month since our resident was tested positive and he is
still testing positive although asymptomatic for a week now How
long we should keep testing
Image Pixabay
Do we really need to keep 6 feet of distance between our coworkers in the break room
Yes
bull Maintain at least 6 feet distance from others especially when mask use is not feasible (such as during eating or drinking)
bull Decrease the number of employees in break areasbull Eat in shifts
bull Go outside to eat
bull Open up additional space for breaks
httpswwwcdcgovcoronavirus2019-ncovcommunityguidance-business-responsehtml for additional tips
Monday ndash Friday
730 AM ndash 930 AM Central Time
200 PM -400 PM Central Time
Call 402-552-2881
IP Office Hours
Questions and Answer SessionUse the QA box in the webinar platform to type a question Questions will be read aloud by the moderator
If your question is not answered during the webinar please either e-mail it to NE ICAP or call during our office hours to speak with one of our IPs
A transcript of the discussion will be made available on the ICAP website
Panelists today are
Dr Salman Ashraf salmanashrafunmceduKate Tyner RN BSN CIC ltynernebraskamedcomMargaret Drake MT(ASCP)CIC MargaretDrakeNebraskagovTeri Fitzgerald RN BSN CIC tfitzgeraldnebraskamedcomDr Ishrat Kamal-Ahmed IshratKamal-AhmednebraskagovAlisha Dorn BSN RN CIC adornnebraskamedcom
httpsicapnebraskamedcomcoronavirushttpsicapnebraskamedcomcovid-19-webinars
Questions and Answer Session
Use the QA box in the webinar platform to type a question Questions will be read aloud by the moderator in the order they are received
A transcript of the discussion will be made available on the ICAP website
Moderated by Mounica Soma MHA
httpsicapnebraskamedcomresources
Responses were provided based on information known on 6162020 and may become out of date
Guidance is being updated rapidly so users should look to CDC and NE DHHS guidance for updates
NETEC ndash NICSNebraska DHHS HAI-ARNebraska ICAP Small and Critical Access Hospitals-Outpatient Region VII Webinar on COVID-19 6162020
1 Do you see recommendation for masks or face coverings going away anytime soon
We donrsquot seeing the recommendation changing because we are still seeing community
transmission of COVID-19 As long as there is community transmission the use of masks or face
coverings will be recommended That is especially true because we see spread that is pre-
symptomatic or asymptomatic We expect the universal mask recommendation to continue at
least until an effective vaccine is developed
2 Do you have any guidance for hospitals in making the decision when it is appropriate to relax
visitor restrictions amp stop temperature checks on everyone Am I safe to assume mandatory
mask wear in a hospital setting will continue through this year and into next year
Visitor restrictions are being loosened in some hospitals allowing one visitor per one patient
Nebraska Medicine has not done this yet Decisions on this will depend on which hospital (and
what is going on inside that hospital) plus things like community transmission what region you
are in The issue is that we are seeing community transmission and sometimes transmission is
happening from people who have minimal symptoms they donrsquot feel ill and donrsquot recognize that
they have COVID-19 We are still seeing people identified when they come to our hospitals who
have fevers and donrsquot even realize that when they try to enter I think the temperature checks
will continue for as long as we have universal masking We will probably see loosening of visitor
restrictions as we go forward if the case counts continue to go down Nebraska Medicine has
continued to identity people who have symptoms and temperatures during the screening
process at the entries Another issue Nebraska Medicine has seen in its hospital and clinic
waiting rooms is to be able to adhere to social distancing if you allow each patient to bring along
a visitor With some of the seats marked off to stay empty Nebraska Medicinersquos clinic waiting
rooms are already at capacity just with the patients There are logistical issues when you
increase the number of people coming into the clinics and hospitals That is something you
need to consider in your facilityrsquos planning
3 In regards to eye protection If a person has a prescription safety glasses are those okay for
use Does the eye protection need to be cleaned when going in and out of patient rooms Do
they need to clean after each patient (non-COVID) if glasses didnt visible become soiled
The prescription safety glasses could be allowed if they are OSHA-approved and we knew where
they were acquired For going in and out of patient rooms Nebraska Medicine treats the eye
protection like other extended use PPE The staff member does not touch the eye protection
and if they do then they do remove them and clean them with disinfectant wipes That also
applies if the eye protection becomes visibly soiled they are taken off and disinfected
Otherwise staff is allowed to continue to keep the eye protection on and wear them for an
extended period of time
4 What is the logic for mass testing long-term care staff prior to Phase II What real benefit is a
snap shot in time test result when you are in a situation that staff come and go between
multiple facilities Can go out in the community without restrictions no accountability to
mask andor social distance The reality is you cant control what staff do in the community
We agree that it is important to know that you cannot control what staff does out in the
community but we can educate staff to follow social distancing and masking in the community
Baseline testing does give you an idea what is going on in your facility at the time when you are
considering opening up or relaxing some of the restrictions It gives you a basic idea of your
facility situation If you do a staff testing and that day the entire staff is negative you know your
risk is lower in your facility and you can start reopening with more confidence If you do find a
number of staff positive when you test it is a sign that you may need to wait to relax
restrictions It is also a sign that there could be residents who are COVID-19 positive that you do
not know about who are asymptomatically or pre-symptomatically positive If you were to open
up at that time there may be increased transmission within the home Thatrsquos because when
you go from Phase I to Phase 2 to Phase 3 you would be increasing activities and resident to
resident interaction in the nursing home Staff testing also gives you an idea of what is going on
with the residents because if all the staff are negative chances are that all the residents would
be negative as well The residents are only getting from the staff at this time so if the staff is all
negative it shows they probably are doing the right thing out in the community or that there is
not much COVID-19 in their community right now
5 Since long-term care facilities are being required to test as a baseline will hospital staff also
need to be tested for a baseline
Nursing home residents are a unique population because they are living in a congregate
community Long term care staff are being tested first because it also gives us approximate
measures of what may be going on in the resident population We know that when restrictions
are being lifted the residents will start interacting with each other again and we want to identify
any positive residents before that happens to avoid transmission Those decisions are being
made by the state and we provide guidance but the statersquos decision are ultimately made by
them The hospitals donrsquot have the same situation where patients are interacting with each
other so that risk factor for transmission of COVID-19 isnrsquot present Hospital staff still needs to
be screened and vigilant and everyone has to wear surgical masks for source control and
personal protection But the situations of care are different so that is why long term care staff
is being tested on a baseline and not hospital staff is being tested on a baseline
6 Is all cautery in surgery a risk or just cautery when it involves the nasal or laryngeal areas
Not all cautery in surgery is the same risk Abdominal cautery would not carry the same risk as
nasal or laryngeal cautery which involves the respiratory system Nebraska Medicine follows
this same idea where there isnrsquot risk involved in cautery on legs arms etc
7 Have long-term care facilities been advised by ICAP to not allow admissions into their facilities
until no one (employee or patients) tests positive
The only time that a facility is not going to have admission is if they cannot take care of the
patient they are admitting (the CMS rule refers to not having the capacity the staff expertise or
the PPE to care for patients) A facility that does not have a way to cohort any existing COVID-19
positive patients or have room to take more patients safely is the only time we would tell a
facility not to admit patients There is guidance about admitting a COVID positive patients ndash if
they are within the 28-day time period they should have a two-test negative before they are
admitted especially if they are going into a facility that has not had a COVID-19 case before
because they wonrsquot have a red zone in place If a facility has already had a COVID-19 positive
case and have a red zone in place (separated from the rest of the facility and they have room
there for another positive patient) that is fine There are a lot of case-by-case decisions to be
made
8 Is there anything guidance I could share with staff not to double their maskswearing a N-95
with a surgical mask over top There is concern to conserve their PPE if wearing goggles that
this helps but concern about compromising the fit as well as comfort
This is an issue of how much PPE you have during this time of inventory shortages You still
want PPE worn correctly so the staff can be directed on the correct way You probably need to
talk to the staff to find out reasons for their concern in not following the protocol for wearing
PPE ndash concern over not having enough N95 masks to wear etc Those should be addressed
You can let ICAP know if you are short of PPE so we can try to help with acquisition of PPE
reprocessing etc Keep control over inventory so they arenrsquot taking PPE that they donrsquot need
Someone on your staff can work with others on their PPE use In general we donrsquot recommend
wearing a surgical mask over an N95 A face shield is a different strategy that can be used over
an N95 We still want to limit the use of N95 to one shift per mask Nebraska Medicine has
seen the use migrate to using an N95 mask (down from using face shields extra procedure
masks) etc and they have not seen COVID transmission or increased burn rates for N95 masks
9 For Alisha in OR when wearing goggles over a face shield do you just have reprocess after
that wear
No you just need to wipe them with disinfectant wipes once you take them off They are not
reprocessed
Yes
bull Long-term care facilities have had stringent infection control processes since March
bull Recommend use of a procedure mask for the residentbull Plus procedure mask for HCW for non-COVID-19 visits
bull Plus N95 respirator gown gloves eye protection for COVID-19 visits
Is there a tool to help me plan for or quantify a potential surge in COVID-19 cases
Image Pixabay
Yes
Here is a CDC tool for calculating a surge in your community
httpswwwcdcgovcoronavirus2019-ncovhcpCOVIDSurgehtml [cdcgov]
It has been a month since our resident was tested positive and he is
still testing positive although asymptomatic for a week now How
long we should keep testing
Image Pixabay
Do we really need to keep 6 feet of distance between our coworkers in the break room
Yes
bull Maintain at least 6 feet distance from others especially when mask use is not feasible (such as during eating or drinking)
bull Decrease the number of employees in break areasbull Eat in shifts
bull Go outside to eat
bull Open up additional space for breaks
httpswwwcdcgovcoronavirus2019-ncovcommunityguidance-business-responsehtml for additional tips
Monday ndash Friday
730 AM ndash 930 AM Central Time
200 PM -400 PM Central Time
Call 402-552-2881
IP Office Hours
Questions and Answer SessionUse the QA box in the webinar platform to type a question Questions will be read aloud by the moderator
If your question is not answered during the webinar please either e-mail it to NE ICAP or call during our office hours to speak with one of our IPs
A transcript of the discussion will be made available on the ICAP website
Panelists today are
Dr Salman Ashraf salmanashrafunmceduKate Tyner RN BSN CIC ltynernebraskamedcomMargaret Drake MT(ASCP)CIC MargaretDrakeNebraskagovTeri Fitzgerald RN BSN CIC tfitzgeraldnebraskamedcomDr Ishrat Kamal-Ahmed IshratKamal-AhmednebraskagovAlisha Dorn BSN RN CIC adornnebraskamedcom
httpsicapnebraskamedcomcoronavirushttpsicapnebraskamedcomcovid-19-webinars
Questions and Answer Session
Use the QA box in the webinar platform to type a question Questions will be read aloud by the moderator in the order they are received
A transcript of the discussion will be made available on the ICAP website
Moderated by Mounica Soma MHA
httpsicapnebraskamedcomresources
Responses were provided based on information known on 6162020 and may become out of date
Guidance is being updated rapidly so users should look to CDC and NE DHHS guidance for updates
NETEC ndash NICSNebraska DHHS HAI-ARNebraska ICAP Small and Critical Access Hospitals-Outpatient Region VII Webinar on COVID-19 6162020
1 Do you see recommendation for masks or face coverings going away anytime soon
We donrsquot seeing the recommendation changing because we are still seeing community
transmission of COVID-19 As long as there is community transmission the use of masks or face
coverings will be recommended That is especially true because we see spread that is pre-
symptomatic or asymptomatic We expect the universal mask recommendation to continue at
least until an effective vaccine is developed
2 Do you have any guidance for hospitals in making the decision when it is appropriate to relax
visitor restrictions amp stop temperature checks on everyone Am I safe to assume mandatory
mask wear in a hospital setting will continue through this year and into next year
Visitor restrictions are being loosened in some hospitals allowing one visitor per one patient
Nebraska Medicine has not done this yet Decisions on this will depend on which hospital (and
what is going on inside that hospital) plus things like community transmission what region you
are in The issue is that we are seeing community transmission and sometimes transmission is
happening from people who have minimal symptoms they donrsquot feel ill and donrsquot recognize that
they have COVID-19 We are still seeing people identified when they come to our hospitals who
have fevers and donrsquot even realize that when they try to enter I think the temperature checks
will continue for as long as we have universal masking We will probably see loosening of visitor
restrictions as we go forward if the case counts continue to go down Nebraska Medicine has
continued to identity people who have symptoms and temperatures during the screening
process at the entries Another issue Nebraska Medicine has seen in its hospital and clinic
waiting rooms is to be able to adhere to social distancing if you allow each patient to bring along
a visitor With some of the seats marked off to stay empty Nebraska Medicinersquos clinic waiting
rooms are already at capacity just with the patients There are logistical issues when you
increase the number of people coming into the clinics and hospitals That is something you
need to consider in your facilityrsquos planning
3 In regards to eye protection If a person has a prescription safety glasses are those okay for
use Does the eye protection need to be cleaned when going in and out of patient rooms Do
they need to clean after each patient (non-COVID) if glasses didnt visible become soiled
The prescription safety glasses could be allowed if they are OSHA-approved and we knew where
they were acquired For going in and out of patient rooms Nebraska Medicine treats the eye
protection like other extended use PPE The staff member does not touch the eye protection
and if they do then they do remove them and clean them with disinfectant wipes That also
applies if the eye protection becomes visibly soiled they are taken off and disinfected
Otherwise staff is allowed to continue to keep the eye protection on and wear them for an
extended period of time
4 What is the logic for mass testing long-term care staff prior to Phase II What real benefit is a
snap shot in time test result when you are in a situation that staff come and go between
multiple facilities Can go out in the community without restrictions no accountability to
mask andor social distance The reality is you cant control what staff do in the community
We agree that it is important to know that you cannot control what staff does out in the
community but we can educate staff to follow social distancing and masking in the community
Baseline testing does give you an idea what is going on in your facility at the time when you are
considering opening up or relaxing some of the restrictions It gives you a basic idea of your
facility situation If you do a staff testing and that day the entire staff is negative you know your
risk is lower in your facility and you can start reopening with more confidence If you do find a
number of staff positive when you test it is a sign that you may need to wait to relax
restrictions It is also a sign that there could be residents who are COVID-19 positive that you do
not know about who are asymptomatically or pre-symptomatically positive If you were to open
up at that time there may be increased transmission within the home Thatrsquos because when
you go from Phase I to Phase 2 to Phase 3 you would be increasing activities and resident to
resident interaction in the nursing home Staff testing also gives you an idea of what is going on
with the residents because if all the staff are negative chances are that all the residents would
be negative as well The residents are only getting from the staff at this time so if the staff is all
negative it shows they probably are doing the right thing out in the community or that there is
not much COVID-19 in their community right now
5 Since long-term care facilities are being required to test as a baseline will hospital staff also
need to be tested for a baseline
Nursing home residents are a unique population because they are living in a congregate
community Long term care staff are being tested first because it also gives us approximate
measures of what may be going on in the resident population We know that when restrictions
are being lifted the residents will start interacting with each other again and we want to identify
any positive residents before that happens to avoid transmission Those decisions are being
made by the state and we provide guidance but the statersquos decision are ultimately made by
them The hospitals donrsquot have the same situation where patients are interacting with each
other so that risk factor for transmission of COVID-19 isnrsquot present Hospital staff still needs to
be screened and vigilant and everyone has to wear surgical masks for source control and
personal protection But the situations of care are different so that is why long term care staff
is being tested on a baseline and not hospital staff is being tested on a baseline
6 Is all cautery in surgery a risk or just cautery when it involves the nasal or laryngeal areas
Not all cautery in surgery is the same risk Abdominal cautery would not carry the same risk as
nasal or laryngeal cautery which involves the respiratory system Nebraska Medicine follows
this same idea where there isnrsquot risk involved in cautery on legs arms etc
7 Have long-term care facilities been advised by ICAP to not allow admissions into their facilities
until no one (employee or patients) tests positive
The only time that a facility is not going to have admission is if they cannot take care of the
patient they are admitting (the CMS rule refers to not having the capacity the staff expertise or
the PPE to care for patients) A facility that does not have a way to cohort any existing COVID-19
positive patients or have room to take more patients safely is the only time we would tell a
facility not to admit patients There is guidance about admitting a COVID positive patients ndash if
they are within the 28-day time period they should have a two-test negative before they are
admitted especially if they are going into a facility that has not had a COVID-19 case before
because they wonrsquot have a red zone in place If a facility has already had a COVID-19 positive
case and have a red zone in place (separated from the rest of the facility and they have room
there for another positive patient) that is fine There are a lot of case-by-case decisions to be
made
8 Is there anything guidance I could share with staff not to double their maskswearing a N-95
with a surgical mask over top There is concern to conserve their PPE if wearing goggles that
this helps but concern about compromising the fit as well as comfort
This is an issue of how much PPE you have during this time of inventory shortages You still
want PPE worn correctly so the staff can be directed on the correct way You probably need to
talk to the staff to find out reasons for their concern in not following the protocol for wearing
PPE ndash concern over not having enough N95 masks to wear etc Those should be addressed
You can let ICAP know if you are short of PPE so we can try to help with acquisition of PPE
reprocessing etc Keep control over inventory so they arenrsquot taking PPE that they donrsquot need
Someone on your staff can work with others on their PPE use In general we donrsquot recommend
wearing a surgical mask over an N95 A face shield is a different strategy that can be used over
an N95 We still want to limit the use of N95 to one shift per mask Nebraska Medicine has
seen the use migrate to using an N95 mask (down from using face shields extra procedure
masks) etc and they have not seen COVID transmission or increased burn rates for N95 masks
9 For Alisha in OR when wearing goggles over a face shield do you just have reprocess after
that wear
No you just need to wipe them with disinfectant wipes once you take them off They are not
reprocessed
Is there a tool to help me plan for or quantify a potential surge in COVID-19 cases
Image Pixabay
Yes
Here is a CDC tool for calculating a surge in your community
httpswwwcdcgovcoronavirus2019-ncovhcpCOVIDSurgehtml [cdcgov]
It has been a month since our resident was tested positive and he is
still testing positive although asymptomatic for a week now How
long we should keep testing
Image Pixabay
Do we really need to keep 6 feet of distance between our coworkers in the break room
Yes
bull Maintain at least 6 feet distance from others especially when mask use is not feasible (such as during eating or drinking)
bull Decrease the number of employees in break areasbull Eat in shifts
bull Go outside to eat
bull Open up additional space for breaks
httpswwwcdcgovcoronavirus2019-ncovcommunityguidance-business-responsehtml for additional tips
Monday ndash Friday
730 AM ndash 930 AM Central Time
200 PM -400 PM Central Time
Call 402-552-2881
IP Office Hours
Questions and Answer SessionUse the QA box in the webinar platform to type a question Questions will be read aloud by the moderator
If your question is not answered during the webinar please either e-mail it to NE ICAP or call during our office hours to speak with one of our IPs
A transcript of the discussion will be made available on the ICAP website
Panelists today are
Dr Salman Ashraf salmanashrafunmceduKate Tyner RN BSN CIC ltynernebraskamedcomMargaret Drake MT(ASCP)CIC MargaretDrakeNebraskagovTeri Fitzgerald RN BSN CIC tfitzgeraldnebraskamedcomDr Ishrat Kamal-Ahmed IshratKamal-AhmednebraskagovAlisha Dorn BSN RN CIC adornnebraskamedcom
httpsicapnebraskamedcomcoronavirushttpsicapnebraskamedcomcovid-19-webinars
Questions and Answer Session
Use the QA box in the webinar platform to type a question Questions will be read aloud by the moderator in the order they are received
A transcript of the discussion will be made available on the ICAP website
Moderated by Mounica Soma MHA
httpsicapnebraskamedcomresources
Responses were provided based on information known on 6162020 and may become out of date
Guidance is being updated rapidly so users should look to CDC and NE DHHS guidance for updates
NETEC ndash NICSNebraska DHHS HAI-ARNebraska ICAP Small and Critical Access Hospitals-Outpatient Region VII Webinar on COVID-19 6162020
1 Do you see recommendation for masks or face coverings going away anytime soon
We donrsquot seeing the recommendation changing because we are still seeing community
transmission of COVID-19 As long as there is community transmission the use of masks or face
coverings will be recommended That is especially true because we see spread that is pre-
symptomatic or asymptomatic We expect the universal mask recommendation to continue at
least until an effective vaccine is developed
2 Do you have any guidance for hospitals in making the decision when it is appropriate to relax
visitor restrictions amp stop temperature checks on everyone Am I safe to assume mandatory
mask wear in a hospital setting will continue through this year and into next year
Visitor restrictions are being loosened in some hospitals allowing one visitor per one patient
Nebraska Medicine has not done this yet Decisions on this will depend on which hospital (and
what is going on inside that hospital) plus things like community transmission what region you
are in The issue is that we are seeing community transmission and sometimes transmission is
happening from people who have minimal symptoms they donrsquot feel ill and donrsquot recognize that
they have COVID-19 We are still seeing people identified when they come to our hospitals who
have fevers and donrsquot even realize that when they try to enter I think the temperature checks
will continue for as long as we have universal masking We will probably see loosening of visitor
restrictions as we go forward if the case counts continue to go down Nebraska Medicine has
continued to identity people who have symptoms and temperatures during the screening
process at the entries Another issue Nebraska Medicine has seen in its hospital and clinic
waiting rooms is to be able to adhere to social distancing if you allow each patient to bring along
a visitor With some of the seats marked off to stay empty Nebraska Medicinersquos clinic waiting
rooms are already at capacity just with the patients There are logistical issues when you
increase the number of people coming into the clinics and hospitals That is something you
need to consider in your facilityrsquos planning
3 In regards to eye protection If a person has a prescription safety glasses are those okay for
use Does the eye protection need to be cleaned when going in and out of patient rooms Do
they need to clean after each patient (non-COVID) if glasses didnt visible become soiled
The prescription safety glasses could be allowed if they are OSHA-approved and we knew where
they were acquired For going in and out of patient rooms Nebraska Medicine treats the eye
protection like other extended use PPE The staff member does not touch the eye protection
and if they do then they do remove them and clean them with disinfectant wipes That also
applies if the eye protection becomes visibly soiled they are taken off and disinfected
Otherwise staff is allowed to continue to keep the eye protection on and wear them for an
extended period of time
4 What is the logic for mass testing long-term care staff prior to Phase II What real benefit is a
snap shot in time test result when you are in a situation that staff come and go between
multiple facilities Can go out in the community without restrictions no accountability to
mask andor social distance The reality is you cant control what staff do in the community
We agree that it is important to know that you cannot control what staff does out in the
community but we can educate staff to follow social distancing and masking in the community
Baseline testing does give you an idea what is going on in your facility at the time when you are
considering opening up or relaxing some of the restrictions It gives you a basic idea of your
facility situation If you do a staff testing and that day the entire staff is negative you know your
risk is lower in your facility and you can start reopening with more confidence If you do find a
number of staff positive when you test it is a sign that you may need to wait to relax
restrictions It is also a sign that there could be residents who are COVID-19 positive that you do
not know about who are asymptomatically or pre-symptomatically positive If you were to open
up at that time there may be increased transmission within the home Thatrsquos because when
you go from Phase I to Phase 2 to Phase 3 you would be increasing activities and resident to
resident interaction in the nursing home Staff testing also gives you an idea of what is going on
with the residents because if all the staff are negative chances are that all the residents would
be negative as well The residents are only getting from the staff at this time so if the staff is all
negative it shows they probably are doing the right thing out in the community or that there is
not much COVID-19 in their community right now
5 Since long-term care facilities are being required to test as a baseline will hospital staff also
need to be tested for a baseline
Nursing home residents are a unique population because they are living in a congregate
community Long term care staff are being tested first because it also gives us approximate
measures of what may be going on in the resident population We know that when restrictions
are being lifted the residents will start interacting with each other again and we want to identify
any positive residents before that happens to avoid transmission Those decisions are being
made by the state and we provide guidance but the statersquos decision are ultimately made by
them The hospitals donrsquot have the same situation where patients are interacting with each
other so that risk factor for transmission of COVID-19 isnrsquot present Hospital staff still needs to
be screened and vigilant and everyone has to wear surgical masks for source control and
personal protection But the situations of care are different so that is why long term care staff
is being tested on a baseline and not hospital staff is being tested on a baseline
6 Is all cautery in surgery a risk or just cautery when it involves the nasal or laryngeal areas
Not all cautery in surgery is the same risk Abdominal cautery would not carry the same risk as
nasal or laryngeal cautery which involves the respiratory system Nebraska Medicine follows
this same idea where there isnrsquot risk involved in cautery on legs arms etc
7 Have long-term care facilities been advised by ICAP to not allow admissions into their facilities
until no one (employee or patients) tests positive
The only time that a facility is not going to have admission is if they cannot take care of the
patient they are admitting (the CMS rule refers to not having the capacity the staff expertise or
the PPE to care for patients) A facility that does not have a way to cohort any existing COVID-19
positive patients or have room to take more patients safely is the only time we would tell a
facility not to admit patients There is guidance about admitting a COVID positive patients ndash if
they are within the 28-day time period they should have a two-test negative before they are
admitted especially if they are going into a facility that has not had a COVID-19 case before
because they wonrsquot have a red zone in place If a facility has already had a COVID-19 positive
case and have a red zone in place (separated from the rest of the facility and they have room
there for another positive patient) that is fine There are a lot of case-by-case decisions to be
made
8 Is there anything guidance I could share with staff not to double their maskswearing a N-95
with a surgical mask over top There is concern to conserve their PPE if wearing goggles that
this helps but concern about compromising the fit as well as comfort
This is an issue of how much PPE you have during this time of inventory shortages You still
want PPE worn correctly so the staff can be directed on the correct way You probably need to
talk to the staff to find out reasons for their concern in not following the protocol for wearing
PPE ndash concern over not having enough N95 masks to wear etc Those should be addressed
You can let ICAP know if you are short of PPE so we can try to help with acquisition of PPE
reprocessing etc Keep control over inventory so they arenrsquot taking PPE that they donrsquot need
Someone on your staff can work with others on their PPE use In general we donrsquot recommend
wearing a surgical mask over an N95 A face shield is a different strategy that can be used over
an N95 We still want to limit the use of N95 to one shift per mask Nebraska Medicine has
seen the use migrate to using an N95 mask (down from using face shields extra procedure
masks) etc and they have not seen COVID transmission or increased burn rates for N95 masks
9 For Alisha in OR when wearing goggles over a face shield do you just have reprocess after
that wear
No you just need to wipe them with disinfectant wipes once you take them off They are not
reprocessed
Yes
Here is a CDC tool for calculating a surge in your community
httpswwwcdcgovcoronavirus2019-ncovhcpCOVIDSurgehtml [cdcgov]
It has been a month since our resident was tested positive and he is
still testing positive although asymptomatic for a week now How
long we should keep testing
Image Pixabay
Do we really need to keep 6 feet of distance between our coworkers in the break room
Yes
bull Maintain at least 6 feet distance from others especially when mask use is not feasible (such as during eating or drinking)
bull Decrease the number of employees in break areasbull Eat in shifts
bull Go outside to eat
bull Open up additional space for breaks
httpswwwcdcgovcoronavirus2019-ncovcommunityguidance-business-responsehtml for additional tips
Monday ndash Friday
730 AM ndash 930 AM Central Time
200 PM -400 PM Central Time
Call 402-552-2881
IP Office Hours
Questions and Answer SessionUse the QA box in the webinar platform to type a question Questions will be read aloud by the moderator
If your question is not answered during the webinar please either e-mail it to NE ICAP or call during our office hours to speak with one of our IPs
A transcript of the discussion will be made available on the ICAP website
Panelists today are
Dr Salman Ashraf salmanashrafunmceduKate Tyner RN BSN CIC ltynernebraskamedcomMargaret Drake MT(ASCP)CIC MargaretDrakeNebraskagovTeri Fitzgerald RN BSN CIC tfitzgeraldnebraskamedcomDr Ishrat Kamal-Ahmed IshratKamal-AhmednebraskagovAlisha Dorn BSN RN CIC adornnebraskamedcom
httpsicapnebraskamedcomcoronavirushttpsicapnebraskamedcomcovid-19-webinars
Questions and Answer Session
Use the QA box in the webinar platform to type a question Questions will be read aloud by the moderator in the order they are received
A transcript of the discussion will be made available on the ICAP website
Moderated by Mounica Soma MHA
httpsicapnebraskamedcomresources
Responses were provided based on information known on 6162020 and may become out of date
Guidance is being updated rapidly so users should look to CDC and NE DHHS guidance for updates
NETEC ndash NICSNebraska DHHS HAI-ARNebraska ICAP Small and Critical Access Hospitals-Outpatient Region VII Webinar on COVID-19 6162020
1 Do you see recommendation for masks or face coverings going away anytime soon
We donrsquot seeing the recommendation changing because we are still seeing community
transmission of COVID-19 As long as there is community transmission the use of masks or face
coverings will be recommended That is especially true because we see spread that is pre-
symptomatic or asymptomatic We expect the universal mask recommendation to continue at
least until an effective vaccine is developed
2 Do you have any guidance for hospitals in making the decision when it is appropriate to relax
visitor restrictions amp stop temperature checks on everyone Am I safe to assume mandatory
mask wear in a hospital setting will continue through this year and into next year
Visitor restrictions are being loosened in some hospitals allowing one visitor per one patient
Nebraska Medicine has not done this yet Decisions on this will depend on which hospital (and
what is going on inside that hospital) plus things like community transmission what region you
are in The issue is that we are seeing community transmission and sometimes transmission is
happening from people who have minimal symptoms they donrsquot feel ill and donrsquot recognize that
they have COVID-19 We are still seeing people identified when they come to our hospitals who
have fevers and donrsquot even realize that when they try to enter I think the temperature checks
will continue for as long as we have universal masking We will probably see loosening of visitor
restrictions as we go forward if the case counts continue to go down Nebraska Medicine has
continued to identity people who have symptoms and temperatures during the screening
process at the entries Another issue Nebraska Medicine has seen in its hospital and clinic
waiting rooms is to be able to adhere to social distancing if you allow each patient to bring along
a visitor With some of the seats marked off to stay empty Nebraska Medicinersquos clinic waiting
rooms are already at capacity just with the patients There are logistical issues when you
increase the number of people coming into the clinics and hospitals That is something you
need to consider in your facilityrsquos planning
3 In regards to eye protection If a person has a prescription safety glasses are those okay for
use Does the eye protection need to be cleaned when going in and out of patient rooms Do
they need to clean after each patient (non-COVID) if glasses didnt visible become soiled
The prescription safety glasses could be allowed if they are OSHA-approved and we knew where
they were acquired For going in and out of patient rooms Nebraska Medicine treats the eye
protection like other extended use PPE The staff member does not touch the eye protection
and if they do then they do remove them and clean them with disinfectant wipes That also
applies if the eye protection becomes visibly soiled they are taken off and disinfected
Otherwise staff is allowed to continue to keep the eye protection on and wear them for an
extended period of time
4 What is the logic for mass testing long-term care staff prior to Phase II What real benefit is a
snap shot in time test result when you are in a situation that staff come and go between
multiple facilities Can go out in the community without restrictions no accountability to
mask andor social distance The reality is you cant control what staff do in the community
We agree that it is important to know that you cannot control what staff does out in the
community but we can educate staff to follow social distancing and masking in the community
Baseline testing does give you an idea what is going on in your facility at the time when you are
considering opening up or relaxing some of the restrictions It gives you a basic idea of your
facility situation If you do a staff testing and that day the entire staff is negative you know your
risk is lower in your facility and you can start reopening with more confidence If you do find a
number of staff positive when you test it is a sign that you may need to wait to relax
restrictions It is also a sign that there could be residents who are COVID-19 positive that you do
not know about who are asymptomatically or pre-symptomatically positive If you were to open
up at that time there may be increased transmission within the home Thatrsquos because when
you go from Phase I to Phase 2 to Phase 3 you would be increasing activities and resident to
resident interaction in the nursing home Staff testing also gives you an idea of what is going on
with the residents because if all the staff are negative chances are that all the residents would
be negative as well The residents are only getting from the staff at this time so if the staff is all
negative it shows they probably are doing the right thing out in the community or that there is
not much COVID-19 in their community right now
5 Since long-term care facilities are being required to test as a baseline will hospital staff also
need to be tested for a baseline
Nursing home residents are a unique population because they are living in a congregate
community Long term care staff are being tested first because it also gives us approximate
measures of what may be going on in the resident population We know that when restrictions
are being lifted the residents will start interacting with each other again and we want to identify
any positive residents before that happens to avoid transmission Those decisions are being
made by the state and we provide guidance but the statersquos decision are ultimately made by
them The hospitals donrsquot have the same situation where patients are interacting with each
other so that risk factor for transmission of COVID-19 isnrsquot present Hospital staff still needs to
be screened and vigilant and everyone has to wear surgical masks for source control and
personal protection But the situations of care are different so that is why long term care staff
is being tested on a baseline and not hospital staff is being tested on a baseline
6 Is all cautery in surgery a risk or just cautery when it involves the nasal or laryngeal areas
Not all cautery in surgery is the same risk Abdominal cautery would not carry the same risk as
nasal or laryngeal cautery which involves the respiratory system Nebraska Medicine follows
this same idea where there isnrsquot risk involved in cautery on legs arms etc
7 Have long-term care facilities been advised by ICAP to not allow admissions into their facilities
until no one (employee or patients) tests positive
The only time that a facility is not going to have admission is if they cannot take care of the
patient they are admitting (the CMS rule refers to not having the capacity the staff expertise or
the PPE to care for patients) A facility that does not have a way to cohort any existing COVID-19
positive patients or have room to take more patients safely is the only time we would tell a
facility not to admit patients There is guidance about admitting a COVID positive patients ndash if
they are within the 28-day time period they should have a two-test negative before they are
admitted especially if they are going into a facility that has not had a COVID-19 case before
because they wonrsquot have a red zone in place If a facility has already had a COVID-19 positive
case and have a red zone in place (separated from the rest of the facility and they have room
there for another positive patient) that is fine There are a lot of case-by-case decisions to be
made
8 Is there anything guidance I could share with staff not to double their maskswearing a N-95
with a surgical mask over top There is concern to conserve their PPE if wearing goggles that
this helps but concern about compromising the fit as well as comfort
This is an issue of how much PPE you have during this time of inventory shortages You still
want PPE worn correctly so the staff can be directed on the correct way You probably need to
talk to the staff to find out reasons for their concern in not following the protocol for wearing
PPE ndash concern over not having enough N95 masks to wear etc Those should be addressed
You can let ICAP know if you are short of PPE so we can try to help with acquisition of PPE
reprocessing etc Keep control over inventory so they arenrsquot taking PPE that they donrsquot need
Someone on your staff can work with others on their PPE use In general we donrsquot recommend
wearing a surgical mask over an N95 A face shield is a different strategy that can be used over
an N95 We still want to limit the use of N95 to one shift per mask Nebraska Medicine has
seen the use migrate to using an N95 mask (down from using face shields extra procedure
masks) etc and they have not seen COVID transmission or increased burn rates for N95 masks
9 For Alisha in OR when wearing goggles over a face shield do you just have reprocess after
that wear
No you just need to wipe them with disinfectant wipes once you take them off They are not
reprocessed
It has been a month since our resident was tested positive and he is
still testing positive although asymptomatic for a week now How
long we should keep testing
Image Pixabay
Do we really need to keep 6 feet of distance between our coworkers in the break room
Yes
bull Maintain at least 6 feet distance from others especially when mask use is not feasible (such as during eating or drinking)
bull Decrease the number of employees in break areasbull Eat in shifts
bull Go outside to eat
bull Open up additional space for breaks
httpswwwcdcgovcoronavirus2019-ncovcommunityguidance-business-responsehtml for additional tips
Monday ndash Friday
730 AM ndash 930 AM Central Time
200 PM -400 PM Central Time
Call 402-552-2881
IP Office Hours
Questions and Answer SessionUse the QA box in the webinar platform to type a question Questions will be read aloud by the moderator
If your question is not answered during the webinar please either e-mail it to NE ICAP or call during our office hours to speak with one of our IPs
A transcript of the discussion will be made available on the ICAP website
Panelists today are
Dr Salman Ashraf salmanashrafunmceduKate Tyner RN BSN CIC ltynernebraskamedcomMargaret Drake MT(ASCP)CIC MargaretDrakeNebraskagovTeri Fitzgerald RN BSN CIC tfitzgeraldnebraskamedcomDr Ishrat Kamal-Ahmed IshratKamal-AhmednebraskagovAlisha Dorn BSN RN CIC adornnebraskamedcom
httpsicapnebraskamedcomcoronavirushttpsicapnebraskamedcomcovid-19-webinars
Questions and Answer Session
Use the QA box in the webinar platform to type a question Questions will be read aloud by the moderator in the order they are received
A transcript of the discussion will be made available on the ICAP website
Moderated by Mounica Soma MHA
httpsicapnebraskamedcomresources
Responses were provided based on information known on 6162020 and may become out of date
Guidance is being updated rapidly so users should look to CDC and NE DHHS guidance for updates
NETEC ndash NICSNebraska DHHS HAI-ARNebraska ICAP Small and Critical Access Hospitals-Outpatient Region VII Webinar on COVID-19 6162020
1 Do you see recommendation for masks or face coverings going away anytime soon
We donrsquot seeing the recommendation changing because we are still seeing community
transmission of COVID-19 As long as there is community transmission the use of masks or face
coverings will be recommended That is especially true because we see spread that is pre-
symptomatic or asymptomatic We expect the universal mask recommendation to continue at
least until an effective vaccine is developed
2 Do you have any guidance for hospitals in making the decision when it is appropriate to relax
visitor restrictions amp stop temperature checks on everyone Am I safe to assume mandatory
mask wear in a hospital setting will continue through this year and into next year
Visitor restrictions are being loosened in some hospitals allowing one visitor per one patient
Nebraska Medicine has not done this yet Decisions on this will depend on which hospital (and
what is going on inside that hospital) plus things like community transmission what region you
are in The issue is that we are seeing community transmission and sometimes transmission is
happening from people who have minimal symptoms they donrsquot feel ill and donrsquot recognize that
they have COVID-19 We are still seeing people identified when they come to our hospitals who
have fevers and donrsquot even realize that when they try to enter I think the temperature checks
will continue for as long as we have universal masking We will probably see loosening of visitor
restrictions as we go forward if the case counts continue to go down Nebraska Medicine has
continued to identity people who have symptoms and temperatures during the screening
process at the entries Another issue Nebraska Medicine has seen in its hospital and clinic
waiting rooms is to be able to adhere to social distancing if you allow each patient to bring along
a visitor With some of the seats marked off to stay empty Nebraska Medicinersquos clinic waiting
rooms are already at capacity just with the patients There are logistical issues when you
increase the number of people coming into the clinics and hospitals That is something you
need to consider in your facilityrsquos planning
3 In regards to eye protection If a person has a prescription safety glasses are those okay for
use Does the eye protection need to be cleaned when going in and out of patient rooms Do
they need to clean after each patient (non-COVID) if glasses didnt visible become soiled
The prescription safety glasses could be allowed if they are OSHA-approved and we knew where
they were acquired For going in and out of patient rooms Nebraska Medicine treats the eye
protection like other extended use PPE The staff member does not touch the eye protection
and if they do then they do remove them and clean them with disinfectant wipes That also
applies if the eye protection becomes visibly soiled they are taken off and disinfected
Otherwise staff is allowed to continue to keep the eye protection on and wear them for an
extended period of time
4 What is the logic for mass testing long-term care staff prior to Phase II What real benefit is a
snap shot in time test result when you are in a situation that staff come and go between
multiple facilities Can go out in the community without restrictions no accountability to
mask andor social distance The reality is you cant control what staff do in the community
We agree that it is important to know that you cannot control what staff does out in the
community but we can educate staff to follow social distancing and masking in the community
Baseline testing does give you an idea what is going on in your facility at the time when you are
considering opening up or relaxing some of the restrictions It gives you a basic idea of your
facility situation If you do a staff testing and that day the entire staff is negative you know your
risk is lower in your facility and you can start reopening with more confidence If you do find a
number of staff positive when you test it is a sign that you may need to wait to relax
restrictions It is also a sign that there could be residents who are COVID-19 positive that you do
not know about who are asymptomatically or pre-symptomatically positive If you were to open
up at that time there may be increased transmission within the home Thatrsquos because when
you go from Phase I to Phase 2 to Phase 3 you would be increasing activities and resident to
resident interaction in the nursing home Staff testing also gives you an idea of what is going on
with the residents because if all the staff are negative chances are that all the residents would
be negative as well The residents are only getting from the staff at this time so if the staff is all
negative it shows they probably are doing the right thing out in the community or that there is
not much COVID-19 in their community right now
5 Since long-term care facilities are being required to test as a baseline will hospital staff also
need to be tested for a baseline
Nursing home residents are a unique population because they are living in a congregate
community Long term care staff are being tested first because it also gives us approximate
measures of what may be going on in the resident population We know that when restrictions
are being lifted the residents will start interacting with each other again and we want to identify
any positive residents before that happens to avoid transmission Those decisions are being
made by the state and we provide guidance but the statersquos decision are ultimately made by
them The hospitals donrsquot have the same situation where patients are interacting with each
other so that risk factor for transmission of COVID-19 isnrsquot present Hospital staff still needs to
be screened and vigilant and everyone has to wear surgical masks for source control and
personal protection But the situations of care are different so that is why long term care staff
is being tested on a baseline and not hospital staff is being tested on a baseline
6 Is all cautery in surgery a risk or just cautery when it involves the nasal or laryngeal areas
Not all cautery in surgery is the same risk Abdominal cautery would not carry the same risk as
nasal or laryngeal cautery which involves the respiratory system Nebraska Medicine follows
this same idea where there isnrsquot risk involved in cautery on legs arms etc
7 Have long-term care facilities been advised by ICAP to not allow admissions into their facilities
until no one (employee or patients) tests positive
The only time that a facility is not going to have admission is if they cannot take care of the
patient they are admitting (the CMS rule refers to not having the capacity the staff expertise or
the PPE to care for patients) A facility that does not have a way to cohort any existing COVID-19
positive patients or have room to take more patients safely is the only time we would tell a
facility not to admit patients There is guidance about admitting a COVID positive patients ndash if
they are within the 28-day time period they should have a two-test negative before they are
admitted especially if they are going into a facility that has not had a COVID-19 case before
because they wonrsquot have a red zone in place If a facility has already had a COVID-19 positive
case and have a red zone in place (separated from the rest of the facility and they have room
there for another positive patient) that is fine There are a lot of case-by-case decisions to be
made
8 Is there anything guidance I could share with staff not to double their maskswearing a N-95
with a surgical mask over top There is concern to conserve their PPE if wearing goggles that
this helps but concern about compromising the fit as well as comfort
This is an issue of how much PPE you have during this time of inventory shortages You still
want PPE worn correctly so the staff can be directed on the correct way You probably need to
talk to the staff to find out reasons for their concern in not following the protocol for wearing
PPE ndash concern over not having enough N95 masks to wear etc Those should be addressed
You can let ICAP know if you are short of PPE so we can try to help with acquisition of PPE
reprocessing etc Keep control over inventory so they arenrsquot taking PPE that they donrsquot need
Someone on your staff can work with others on their PPE use In general we donrsquot recommend
wearing a surgical mask over an N95 A face shield is a different strategy that can be used over
an N95 We still want to limit the use of N95 to one shift per mask Nebraska Medicine has
seen the use migrate to using an N95 mask (down from using face shields extra procedure
masks) etc and they have not seen COVID transmission or increased burn rates for N95 masks
9 For Alisha in OR when wearing goggles over a face shield do you just have reprocess after
that wear
No you just need to wipe them with disinfectant wipes once you take them off They are not
reprocessed
Yes
bull Maintain at least 6 feet distance from others especially when mask use is not feasible (such as during eating or drinking)
bull Decrease the number of employees in break areasbull Eat in shifts
bull Go outside to eat
bull Open up additional space for breaks
httpswwwcdcgovcoronavirus2019-ncovcommunityguidance-business-responsehtml for additional tips
Monday ndash Friday
730 AM ndash 930 AM Central Time
200 PM -400 PM Central Time
Call 402-552-2881
IP Office Hours
Questions and Answer SessionUse the QA box in the webinar platform to type a question Questions will be read aloud by the moderator
If your question is not answered during the webinar please either e-mail it to NE ICAP or call during our office hours to speak with one of our IPs
A transcript of the discussion will be made available on the ICAP website
Panelists today are
Dr Salman Ashraf salmanashrafunmceduKate Tyner RN BSN CIC ltynernebraskamedcomMargaret Drake MT(ASCP)CIC MargaretDrakeNebraskagovTeri Fitzgerald RN BSN CIC tfitzgeraldnebraskamedcomDr Ishrat Kamal-Ahmed IshratKamal-AhmednebraskagovAlisha Dorn BSN RN CIC adornnebraskamedcom
httpsicapnebraskamedcomcoronavirushttpsicapnebraskamedcomcovid-19-webinars
Questions and Answer Session
Use the QA box in the webinar platform to type a question Questions will be read aloud by the moderator in the order they are received
A transcript of the discussion will be made available on the ICAP website
Moderated by Mounica Soma MHA
httpsicapnebraskamedcomresources
Responses were provided based on information known on 6162020 and may become out of date
Guidance is being updated rapidly so users should look to CDC and NE DHHS guidance for updates
NETEC ndash NICSNebraska DHHS HAI-ARNebraska ICAP Small and Critical Access Hospitals-Outpatient Region VII Webinar on COVID-19 6162020
1 Do you see recommendation for masks or face coverings going away anytime soon
We donrsquot seeing the recommendation changing because we are still seeing community
transmission of COVID-19 As long as there is community transmission the use of masks or face
coverings will be recommended That is especially true because we see spread that is pre-
symptomatic or asymptomatic We expect the universal mask recommendation to continue at
least until an effective vaccine is developed
2 Do you have any guidance for hospitals in making the decision when it is appropriate to relax
visitor restrictions amp stop temperature checks on everyone Am I safe to assume mandatory
mask wear in a hospital setting will continue through this year and into next year
Visitor restrictions are being loosened in some hospitals allowing one visitor per one patient
Nebraska Medicine has not done this yet Decisions on this will depend on which hospital (and
what is going on inside that hospital) plus things like community transmission what region you
are in The issue is that we are seeing community transmission and sometimes transmission is
happening from people who have minimal symptoms they donrsquot feel ill and donrsquot recognize that
they have COVID-19 We are still seeing people identified when they come to our hospitals who
have fevers and donrsquot even realize that when they try to enter I think the temperature checks
will continue for as long as we have universal masking We will probably see loosening of visitor
restrictions as we go forward if the case counts continue to go down Nebraska Medicine has
continued to identity people who have symptoms and temperatures during the screening
process at the entries Another issue Nebraska Medicine has seen in its hospital and clinic
waiting rooms is to be able to adhere to social distancing if you allow each patient to bring along
a visitor With some of the seats marked off to stay empty Nebraska Medicinersquos clinic waiting
rooms are already at capacity just with the patients There are logistical issues when you
increase the number of people coming into the clinics and hospitals That is something you
need to consider in your facilityrsquos planning
3 In regards to eye protection If a person has a prescription safety glasses are those okay for
use Does the eye protection need to be cleaned when going in and out of patient rooms Do
they need to clean after each patient (non-COVID) if glasses didnt visible become soiled
The prescription safety glasses could be allowed if they are OSHA-approved and we knew where
they were acquired For going in and out of patient rooms Nebraska Medicine treats the eye
protection like other extended use PPE The staff member does not touch the eye protection
and if they do then they do remove them and clean them with disinfectant wipes That also
applies if the eye protection becomes visibly soiled they are taken off and disinfected
Otherwise staff is allowed to continue to keep the eye protection on and wear them for an
extended period of time
4 What is the logic for mass testing long-term care staff prior to Phase II What real benefit is a
snap shot in time test result when you are in a situation that staff come and go between
multiple facilities Can go out in the community without restrictions no accountability to
mask andor social distance The reality is you cant control what staff do in the community
We agree that it is important to know that you cannot control what staff does out in the
community but we can educate staff to follow social distancing and masking in the community
Baseline testing does give you an idea what is going on in your facility at the time when you are
considering opening up or relaxing some of the restrictions It gives you a basic idea of your
facility situation If you do a staff testing and that day the entire staff is negative you know your
risk is lower in your facility and you can start reopening with more confidence If you do find a
number of staff positive when you test it is a sign that you may need to wait to relax
restrictions It is also a sign that there could be residents who are COVID-19 positive that you do
not know about who are asymptomatically or pre-symptomatically positive If you were to open
up at that time there may be increased transmission within the home Thatrsquos because when
you go from Phase I to Phase 2 to Phase 3 you would be increasing activities and resident to
resident interaction in the nursing home Staff testing also gives you an idea of what is going on
with the residents because if all the staff are negative chances are that all the residents would
be negative as well The residents are only getting from the staff at this time so if the staff is all
negative it shows they probably are doing the right thing out in the community or that there is
not much COVID-19 in their community right now
5 Since long-term care facilities are being required to test as a baseline will hospital staff also
need to be tested for a baseline
Nursing home residents are a unique population because they are living in a congregate
community Long term care staff are being tested first because it also gives us approximate
measures of what may be going on in the resident population We know that when restrictions
are being lifted the residents will start interacting with each other again and we want to identify
any positive residents before that happens to avoid transmission Those decisions are being
made by the state and we provide guidance but the statersquos decision are ultimately made by
them The hospitals donrsquot have the same situation where patients are interacting with each
other so that risk factor for transmission of COVID-19 isnrsquot present Hospital staff still needs to
be screened and vigilant and everyone has to wear surgical masks for source control and
personal protection But the situations of care are different so that is why long term care staff
is being tested on a baseline and not hospital staff is being tested on a baseline
6 Is all cautery in surgery a risk or just cautery when it involves the nasal or laryngeal areas
Not all cautery in surgery is the same risk Abdominal cautery would not carry the same risk as
nasal or laryngeal cautery which involves the respiratory system Nebraska Medicine follows
this same idea where there isnrsquot risk involved in cautery on legs arms etc
7 Have long-term care facilities been advised by ICAP to not allow admissions into their facilities
until no one (employee or patients) tests positive
The only time that a facility is not going to have admission is if they cannot take care of the
patient they are admitting (the CMS rule refers to not having the capacity the staff expertise or
the PPE to care for patients) A facility that does not have a way to cohort any existing COVID-19
positive patients or have room to take more patients safely is the only time we would tell a
facility not to admit patients There is guidance about admitting a COVID positive patients ndash if
they are within the 28-day time period they should have a two-test negative before they are
admitted especially if they are going into a facility that has not had a COVID-19 case before
because they wonrsquot have a red zone in place If a facility has already had a COVID-19 positive
case and have a red zone in place (separated from the rest of the facility and they have room
there for another positive patient) that is fine There are a lot of case-by-case decisions to be
made
8 Is there anything guidance I could share with staff not to double their maskswearing a N-95
with a surgical mask over top There is concern to conserve their PPE if wearing goggles that
this helps but concern about compromising the fit as well as comfort
This is an issue of how much PPE you have during this time of inventory shortages You still
want PPE worn correctly so the staff can be directed on the correct way You probably need to
talk to the staff to find out reasons for their concern in not following the protocol for wearing
PPE ndash concern over not having enough N95 masks to wear etc Those should be addressed
You can let ICAP know if you are short of PPE so we can try to help with acquisition of PPE
reprocessing etc Keep control over inventory so they arenrsquot taking PPE that they donrsquot need
Someone on your staff can work with others on their PPE use In general we donrsquot recommend
wearing a surgical mask over an N95 A face shield is a different strategy that can be used over
an N95 We still want to limit the use of N95 to one shift per mask Nebraska Medicine has
seen the use migrate to using an N95 mask (down from using face shields extra procedure
masks) etc and they have not seen COVID transmission or increased burn rates for N95 masks
9 For Alisha in OR when wearing goggles over a face shield do you just have reprocess after
that wear
No you just need to wipe them with disinfectant wipes once you take them off They are not
reprocessed
Monday ndash Friday
730 AM ndash 930 AM Central Time
200 PM -400 PM Central Time
Call 402-552-2881
IP Office Hours
Questions and Answer SessionUse the QA box in the webinar platform to type a question Questions will be read aloud by the moderator
If your question is not answered during the webinar please either e-mail it to NE ICAP or call during our office hours to speak with one of our IPs
A transcript of the discussion will be made available on the ICAP website
Panelists today are
Dr Salman Ashraf salmanashrafunmceduKate Tyner RN BSN CIC ltynernebraskamedcomMargaret Drake MT(ASCP)CIC MargaretDrakeNebraskagovTeri Fitzgerald RN BSN CIC tfitzgeraldnebraskamedcomDr Ishrat Kamal-Ahmed IshratKamal-AhmednebraskagovAlisha Dorn BSN RN CIC adornnebraskamedcom
httpsicapnebraskamedcomcoronavirushttpsicapnebraskamedcomcovid-19-webinars
Questions and Answer Session
Use the QA box in the webinar platform to type a question Questions will be read aloud by the moderator in the order they are received
A transcript of the discussion will be made available on the ICAP website
Moderated by Mounica Soma MHA
httpsicapnebraskamedcomresources
Responses were provided based on information known on 6162020 and may become out of date
Guidance is being updated rapidly so users should look to CDC and NE DHHS guidance for updates
NETEC ndash NICSNebraska DHHS HAI-ARNebraska ICAP Small and Critical Access Hospitals-Outpatient Region VII Webinar on COVID-19 6162020
1 Do you see recommendation for masks or face coverings going away anytime soon
We donrsquot seeing the recommendation changing because we are still seeing community
transmission of COVID-19 As long as there is community transmission the use of masks or face
coverings will be recommended That is especially true because we see spread that is pre-
symptomatic or asymptomatic We expect the universal mask recommendation to continue at
least until an effective vaccine is developed
2 Do you have any guidance for hospitals in making the decision when it is appropriate to relax
visitor restrictions amp stop temperature checks on everyone Am I safe to assume mandatory
mask wear in a hospital setting will continue through this year and into next year
Visitor restrictions are being loosened in some hospitals allowing one visitor per one patient
Nebraska Medicine has not done this yet Decisions on this will depend on which hospital (and
what is going on inside that hospital) plus things like community transmission what region you
are in The issue is that we are seeing community transmission and sometimes transmission is
happening from people who have minimal symptoms they donrsquot feel ill and donrsquot recognize that
they have COVID-19 We are still seeing people identified when they come to our hospitals who
have fevers and donrsquot even realize that when they try to enter I think the temperature checks
will continue for as long as we have universal masking We will probably see loosening of visitor
restrictions as we go forward if the case counts continue to go down Nebraska Medicine has
continued to identity people who have symptoms and temperatures during the screening
process at the entries Another issue Nebraska Medicine has seen in its hospital and clinic
waiting rooms is to be able to adhere to social distancing if you allow each patient to bring along
a visitor With some of the seats marked off to stay empty Nebraska Medicinersquos clinic waiting
rooms are already at capacity just with the patients There are logistical issues when you
increase the number of people coming into the clinics and hospitals That is something you
need to consider in your facilityrsquos planning
3 In regards to eye protection If a person has a prescription safety glasses are those okay for
use Does the eye protection need to be cleaned when going in and out of patient rooms Do
they need to clean after each patient (non-COVID) if glasses didnt visible become soiled
The prescription safety glasses could be allowed if they are OSHA-approved and we knew where
they were acquired For going in and out of patient rooms Nebraska Medicine treats the eye
protection like other extended use PPE The staff member does not touch the eye protection
and if they do then they do remove them and clean them with disinfectant wipes That also
applies if the eye protection becomes visibly soiled they are taken off and disinfected
Otherwise staff is allowed to continue to keep the eye protection on and wear them for an
extended period of time
4 What is the logic for mass testing long-term care staff prior to Phase II What real benefit is a
snap shot in time test result when you are in a situation that staff come and go between
multiple facilities Can go out in the community without restrictions no accountability to
mask andor social distance The reality is you cant control what staff do in the community
We agree that it is important to know that you cannot control what staff does out in the
community but we can educate staff to follow social distancing and masking in the community
Baseline testing does give you an idea what is going on in your facility at the time when you are
considering opening up or relaxing some of the restrictions It gives you a basic idea of your
facility situation If you do a staff testing and that day the entire staff is negative you know your
risk is lower in your facility and you can start reopening with more confidence If you do find a
number of staff positive when you test it is a sign that you may need to wait to relax
restrictions It is also a sign that there could be residents who are COVID-19 positive that you do
not know about who are asymptomatically or pre-symptomatically positive If you were to open
up at that time there may be increased transmission within the home Thatrsquos because when
you go from Phase I to Phase 2 to Phase 3 you would be increasing activities and resident to
resident interaction in the nursing home Staff testing also gives you an idea of what is going on
with the residents because if all the staff are negative chances are that all the residents would
be negative as well The residents are only getting from the staff at this time so if the staff is all
negative it shows they probably are doing the right thing out in the community or that there is
not much COVID-19 in their community right now
5 Since long-term care facilities are being required to test as a baseline will hospital staff also
need to be tested for a baseline
Nursing home residents are a unique population because they are living in a congregate
community Long term care staff are being tested first because it also gives us approximate
measures of what may be going on in the resident population We know that when restrictions
are being lifted the residents will start interacting with each other again and we want to identify
any positive residents before that happens to avoid transmission Those decisions are being
made by the state and we provide guidance but the statersquos decision are ultimately made by
them The hospitals donrsquot have the same situation where patients are interacting with each
other so that risk factor for transmission of COVID-19 isnrsquot present Hospital staff still needs to
be screened and vigilant and everyone has to wear surgical masks for source control and
personal protection But the situations of care are different so that is why long term care staff
is being tested on a baseline and not hospital staff is being tested on a baseline
6 Is all cautery in surgery a risk or just cautery when it involves the nasal or laryngeal areas
Not all cautery in surgery is the same risk Abdominal cautery would not carry the same risk as
nasal or laryngeal cautery which involves the respiratory system Nebraska Medicine follows
this same idea where there isnrsquot risk involved in cautery on legs arms etc
7 Have long-term care facilities been advised by ICAP to not allow admissions into their facilities
until no one (employee or patients) tests positive
The only time that a facility is not going to have admission is if they cannot take care of the
patient they are admitting (the CMS rule refers to not having the capacity the staff expertise or
the PPE to care for patients) A facility that does not have a way to cohort any existing COVID-19
positive patients or have room to take more patients safely is the only time we would tell a
facility not to admit patients There is guidance about admitting a COVID positive patients ndash if
they are within the 28-day time period they should have a two-test negative before they are
admitted especially if they are going into a facility that has not had a COVID-19 case before
because they wonrsquot have a red zone in place If a facility has already had a COVID-19 positive
case and have a red zone in place (separated from the rest of the facility and they have room
there for another positive patient) that is fine There are a lot of case-by-case decisions to be
made
8 Is there anything guidance I could share with staff not to double their maskswearing a N-95
with a surgical mask over top There is concern to conserve their PPE if wearing goggles that
this helps but concern about compromising the fit as well as comfort
This is an issue of how much PPE you have during this time of inventory shortages You still
want PPE worn correctly so the staff can be directed on the correct way You probably need to
talk to the staff to find out reasons for their concern in not following the protocol for wearing
PPE ndash concern over not having enough N95 masks to wear etc Those should be addressed
You can let ICAP know if you are short of PPE so we can try to help with acquisition of PPE
reprocessing etc Keep control over inventory so they arenrsquot taking PPE that they donrsquot need
Someone on your staff can work with others on their PPE use In general we donrsquot recommend
wearing a surgical mask over an N95 A face shield is a different strategy that can be used over
an N95 We still want to limit the use of N95 to one shift per mask Nebraska Medicine has
seen the use migrate to using an N95 mask (down from using face shields extra procedure
masks) etc and they have not seen COVID transmission or increased burn rates for N95 masks
9 For Alisha in OR when wearing goggles over a face shield do you just have reprocess after
that wear
No you just need to wipe them with disinfectant wipes once you take them off They are not
reprocessed
Questions and Answer SessionUse the QA box in the webinar platform to type a question Questions will be read aloud by the moderator
If your question is not answered during the webinar please either e-mail it to NE ICAP or call during our office hours to speak with one of our IPs
A transcript of the discussion will be made available on the ICAP website
Panelists today are
Dr Salman Ashraf salmanashrafunmceduKate Tyner RN BSN CIC ltynernebraskamedcomMargaret Drake MT(ASCP)CIC MargaretDrakeNebraskagovTeri Fitzgerald RN BSN CIC tfitzgeraldnebraskamedcomDr Ishrat Kamal-Ahmed IshratKamal-AhmednebraskagovAlisha Dorn BSN RN CIC adornnebraskamedcom
httpsicapnebraskamedcomcoronavirushttpsicapnebraskamedcomcovid-19-webinars
Questions and Answer Session
Use the QA box in the webinar platform to type a question Questions will be read aloud by the moderator in the order they are received
A transcript of the discussion will be made available on the ICAP website
Moderated by Mounica Soma MHA
httpsicapnebraskamedcomresources
Responses were provided based on information known on 6162020 and may become out of date
Guidance is being updated rapidly so users should look to CDC and NE DHHS guidance for updates
NETEC ndash NICSNebraska DHHS HAI-ARNebraska ICAP Small and Critical Access Hospitals-Outpatient Region VII Webinar on COVID-19 6162020
1 Do you see recommendation for masks or face coverings going away anytime soon
We donrsquot seeing the recommendation changing because we are still seeing community
transmission of COVID-19 As long as there is community transmission the use of masks or face
coverings will be recommended That is especially true because we see spread that is pre-
symptomatic or asymptomatic We expect the universal mask recommendation to continue at
least until an effective vaccine is developed
2 Do you have any guidance for hospitals in making the decision when it is appropriate to relax
visitor restrictions amp stop temperature checks on everyone Am I safe to assume mandatory
mask wear in a hospital setting will continue through this year and into next year
Visitor restrictions are being loosened in some hospitals allowing one visitor per one patient
Nebraska Medicine has not done this yet Decisions on this will depend on which hospital (and
what is going on inside that hospital) plus things like community transmission what region you
are in The issue is that we are seeing community transmission and sometimes transmission is
happening from people who have minimal symptoms they donrsquot feel ill and donrsquot recognize that
they have COVID-19 We are still seeing people identified when they come to our hospitals who
have fevers and donrsquot even realize that when they try to enter I think the temperature checks
will continue for as long as we have universal masking We will probably see loosening of visitor
restrictions as we go forward if the case counts continue to go down Nebraska Medicine has
continued to identity people who have symptoms and temperatures during the screening
process at the entries Another issue Nebraska Medicine has seen in its hospital and clinic
waiting rooms is to be able to adhere to social distancing if you allow each patient to bring along
a visitor With some of the seats marked off to stay empty Nebraska Medicinersquos clinic waiting
rooms are already at capacity just with the patients There are logistical issues when you
increase the number of people coming into the clinics and hospitals That is something you
need to consider in your facilityrsquos planning
3 In regards to eye protection If a person has a prescription safety glasses are those okay for
use Does the eye protection need to be cleaned when going in and out of patient rooms Do
they need to clean after each patient (non-COVID) if glasses didnt visible become soiled
The prescription safety glasses could be allowed if they are OSHA-approved and we knew where
they were acquired For going in and out of patient rooms Nebraska Medicine treats the eye
protection like other extended use PPE The staff member does not touch the eye protection
and if they do then they do remove them and clean them with disinfectant wipes That also
applies if the eye protection becomes visibly soiled they are taken off and disinfected
Otherwise staff is allowed to continue to keep the eye protection on and wear them for an
extended period of time
4 What is the logic for mass testing long-term care staff prior to Phase II What real benefit is a
snap shot in time test result when you are in a situation that staff come and go between
multiple facilities Can go out in the community without restrictions no accountability to
mask andor social distance The reality is you cant control what staff do in the community
We agree that it is important to know that you cannot control what staff does out in the
community but we can educate staff to follow social distancing and masking in the community
Baseline testing does give you an idea what is going on in your facility at the time when you are
considering opening up or relaxing some of the restrictions It gives you a basic idea of your
facility situation If you do a staff testing and that day the entire staff is negative you know your
risk is lower in your facility and you can start reopening with more confidence If you do find a
number of staff positive when you test it is a sign that you may need to wait to relax
restrictions It is also a sign that there could be residents who are COVID-19 positive that you do
not know about who are asymptomatically or pre-symptomatically positive If you were to open
up at that time there may be increased transmission within the home Thatrsquos because when
you go from Phase I to Phase 2 to Phase 3 you would be increasing activities and resident to
resident interaction in the nursing home Staff testing also gives you an idea of what is going on
with the residents because if all the staff are negative chances are that all the residents would
be negative as well The residents are only getting from the staff at this time so if the staff is all
negative it shows they probably are doing the right thing out in the community or that there is
not much COVID-19 in their community right now
5 Since long-term care facilities are being required to test as a baseline will hospital staff also
need to be tested for a baseline
Nursing home residents are a unique population because they are living in a congregate
community Long term care staff are being tested first because it also gives us approximate
measures of what may be going on in the resident population We know that when restrictions
are being lifted the residents will start interacting with each other again and we want to identify
any positive residents before that happens to avoid transmission Those decisions are being
made by the state and we provide guidance but the statersquos decision are ultimately made by
them The hospitals donrsquot have the same situation where patients are interacting with each
other so that risk factor for transmission of COVID-19 isnrsquot present Hospital staff still needs to
be screened and vigilant and everyone has to wear surgical masks for source control and
personal protection But the situations of care are different so that is why long term care staff
is being tested on a baseline and not hospital staff is being tested on a baseline
6 Is all cautery in surgery a risk or just cautery when it involves the nasal or laryngeal areas
Not all cautery in surgery is the same risk Abdominal cautery would not carry the same risk as
nasal or laryngeal cautery which involves the respiratory system Nebraska Medicine follows
this same idea where there isnrsquot risk involved in cautery on legs arms etc
7 Have long-term care facilities been advised by ICAP to not allow admissions into their facilities
until no one (employee or patients) tests positive
The only time that a facility is not going to have admission is if they cannot take care of the
patient they are admitting (the CMS rule refers to not having the capacity the staff expertise or
the PPE to care for patients) A facility that does not have a way to cohort any existing COVID-19
positive patients or have room to take more patients safely is the only time we would tell a
facility not to admit patients There is guidance about admitting a COVID positive patients ndash if
they are within the 28-day time period they should have a two-test negative before they are
admitted especially if they are going into a facility that has not had a COVID-19 case before
because they wonrsquot have a red zone in place If a facility has already had a COVID-19 positive
case and have a red zone in place (separated from the rest of the facility and they have room
there for another positive patient) that is fine There are a lot of case-by-case decisions to be
made
8 Is there anything guidance I could share with staff not to double their maskswearing a N-95
with a surgical mask over top There is concern to conserve their PPE if wearing goggles that
this helps but concern about compromising the fit as well as comfort
This is an issue of how much PPE you have during this time of inventory shortages You still
want PPE worn correctly so the staff can be directed on the correct way You probably need to
talk to the staff to find out reasons for their concern in not following the protocol for wearing
PPE ndash concern over not having enough N95 masks to wear etc Those should be addressed
You can let ICAP know if you are short of PPE so we can try to help with acquisition of PPE
reprocessing etc Keep control over inventory so they arenrsquot taking PPE that they donrsquot need
Someone on your staff can work with others on their PPE use In general we donrsquot recommend
wearing a surgical mask over an N95 A face shield is a different strategy that can be used over
an N95 We still want to limit the use of N95 to one shift per mask Nebraska Medicine has
seen the use migrate to using an N95 mask (down from using face shields extra procedure
masks) etc and they have not seen COVID transmission or increased burn rates for N95 masks
9 For Alisha in OR when wearing goggles over a face shield do you just have reprocess after
that wear
No you just need to wipe them with disinfectant wipes once you take them off They are not
reprocessed
Questions and Answer Session
Use the QA box in the webinar platform to type a question Questions will be read aloud by the moderator in the order they are received
A transcript of the discussion will be made available on the ICAP website
Moderated by Mounica Soma MHA
httpsicapnebraskamedcomresources
Responses were provided based on information known on 6162020 and may become out of date
Guidance is being updated rapidly so users should look to CDC and NE DHHS guidance for updates
NETEC ndash NICSNebraska DHHS HAI-ARNebraska ICAP Small and Critical Access Hospitals-Outpatient Region VII Webinar on COVID-19 6162020
1 Do you see recommendation for masks or face coverings going away anytime soon
We donrsquot seeing the recommendation changing because we are still seeing community
transmission of COVID-19 As long as there is community transmission the use of masks or face
coverings will be recommended That is especially true because we see spread that is pre-
symptomatic or asymptomatic We expect the universal mask recommendation to continue at
least until an effective vaccine is developed
2 Do you have any guidance for hospitals in making the decision when it is appropriate to relax
visitor restrictions amp stop temperature checks on everyone Am I safe to assume mandatory
mask wear in a hospital setting will continue through this year and into next year
Visitor restrictions are being loosened in some hospitals allowing one visitor per one patient
Nebraska Medicine has not done this yet Decisions on this will depend on which hospital (and
what is going on inside that hospital) plus things like community transmission what region you
are in The issue is that we are seeing community transmission and sometimes transmission is
happening from people who have minimal symptoms they donrsquot feel ill and donrsquot recognize that
they have COVID-19 We are still seeing people identified when they come to our hospitals who
have fevers and donrsquot even realize that when they try to enter I think the temperature checks
will continue for as long as we have universal masking We will probably see loosening of visitor
restrictions as we go forward if the case counts continue to go down Nebraska Medicine has
continued to identity people who have symptoms and temperatures during the screening
process at the entries Another issue Nebraska Medicine has seen in its hospital and clinic
waiting rooms is to be able to adhere to social distancing if you allow each patient to bring along
a visitor With some of the seats marked off to stay empty Nebraska Medicinersquos clinic waiting
rooms are already at capacity just with the patients There are logistical issues when you
increase the number of people coming into the clinics and hospitals That is something you
need to consider in your facilityrsquos planning
3 In regards to eye protection If a person has a prescription safety glasses are those okay for
use Does the eye protection need to be cleaned when going in and out of patient rooms Do
they need to clean after each patient (non-COVID) if glasses didnt visible become soiled
The prescription safety glasses could be allowed if they are OSHA-approved and we knew where
they were acquired For going in and out of patient rooms Nebraska Medicine treats the eye
protection like other extended use PPE The staff member does not touch the eye protection
and if they do then they do remove them and clean them with disinfectant wipes That also
applies if the eye protection becomes visibly soiled they are taken off and disinfected
Otherwise staff is allowed to continue to keep the eye protection on and wear them for an
extended period of time
4 What is the logic for mass testing long-term care staff prior to Phase II What real benefit is a
snap shot in time test result when you are in a situation that staff come and go between
multiple facilities Can go out in the community without restrictions no accountability to
mask andor social distance The reality is you cant control what staff do in the community
We agree that it is important to know that you cannot control what staff does out in the
community but we can educate staff to follow social distancing and masking in the community
Baseline testing does give you an idea what is going on in your facility at the time when you are
considering opening up or relaxing some of the restrictions It gives you a basic idea of your
facility situation If you do a staff testing and that day the entire staff is negative you know your
risk is lower in your facility and you can start reopening with more confidence If you do find a
number of staff positive when you test it is a sign that you may need to wait to relax
restrictions It is also a sign that there could be residents who are COVID-19 positive that you do
not know about who are asymptomatically or pre-symptomatically positive If you were to open
up at that time there may be increased transmission within the home Thatrsquos because when
you go from Phase I to Phase 2 to Phase 3 you would be increasing activities and resident to
resident interaction in the nursing home Staff testing also gives you an idea of what is going on
with the residents because if all the staff are negative chances are that all the residents would
be negative as well The residents are only getting from the staff at this time so if the staff is all
negative it shows they probably are doing the right thing out in the community or that there is
not much COVID-19 in their community right now
5 Since long-term care facilities are being required to test as a baseline will hospital staff also
need to be tested for a baseline
Nursing home residents are a unique population because they are living in a congregate
community Long term care staff are being tested first because it also gives us approximate
measures of what may be going on in the resident population We know that when restrictions
are being lifted the residents will start interacting with each other again and we want to identify
any positive residents before that happens to avoid transmission Those decisions are being
made by the state and we provide guidance but the statersquos decision are ultimately made by
them The hospitals donrsquot have the same situation where patients are interacting with each
other so that risk factor for transmission of COVID-19 isnrsquot present Hospital staff still needs to
be screened and vigilant and everyone has to wear surgical masks for source control and
personal protection But the situations of care are different so that is why long term care staff
is being tested on a baseline and not hospital staff is being tested on a baseline
6 Is all cautery in surgery a risk or just cautery when it involves the nasal or laryngeal areas
Not all cautery in surgery is the same risk Abdominal cautery would not carry the same risk as
nasal or laryngeal cautery which involves the respiratory system Nebraska Medicine follows
this same idea where there isnrsquot risk involved in cautery on legs arms etc
7 Have long-term care facilities been advised by ICAP to not allow admissions into their facilities
until no one (employee or patients) tests positive
The only time that a facility is not going to have admission is if they cannot take care of the
patient they are admitting (the CMS rule refers to not having the capacity the staff expertise or
the PPE to care for patients) A facility that does not have a way to cohort any existing COVID-19
positive patients or have room to take more patients safely is the only time we would tell a
facility not to admit patients There is guidance about admitting a COVID positive patients ndash if
they are within the 28-day time period they should have a two-test negative before they are
admitted especially if they are going into a facility that has not had a COVID-19 case before
because they wonrsquot have a red zone in place If a facility has already had a COVID-19 positive
case and have a red zone in place (separated from the rest of the facility and they have room
there for another positive patient) that is fine There are a lot of case-by-case decisions to be
made
8 Is there anything guidance I could share with staff not to double their maskswearing a N-95
with a surgical mask over top There is concern to conserve their PPE if wearing goggles that
this helps but concern about compromising the fit as well as comfort
This is an issue of how much PPE you have during this time of inventory shortages You still
want PPE worn correctly so the staff can be directed on the correct way You probably need to
talk to the staff to find out reasons for their concern in not following the protocol for wearing
PPE ndash concern over not having enough N95 masks to wear etc Those should be addressed
You can let ICAP know if you are short of PPE so we can try to help with acquisition of PPE
reprocessing etc Keep control over inventory so they arenrsquot taking PPE that they donrsquot need
Someone on your staff can work with others on their PPE use In general we donrsquot recommend
wearing a surgical mask over an N95 A face shield is a different strategy that can be used over
an N95 We still want to limit the use of N95 to one shift per mask Nebraska Medicine has
seen the use migrate to using an N95 mask (down from using face shields extra procedure
masks) etc and they have not seen COVID transmission or increased burn rates for N95 masks
9 For Alisha in OR when wearing goggles over a face shield do you just have reprocess after
that wear
No you just need to wipe them with disinfectant wipes once you take them off They are not
reprocessed
Responses were provided based on information known on 6162020 and may become out of date
Guidance is being updated rapidly so users should look to CDC and NE DHHS guidance for updates
NETEC ndash NICSNebraska DHHS HAI-ARNebraska ICAP Small and Critical Access Hospitals-Outpatient Region VII Webinar on COVID-19 6162020
1 Do you see recommendation for masks or face coverings going away anytime soon
We donrsquot seeing the recommendation changing because we are still seeing community
transmission of COVID-19 As long as there is community transmission the use of masks or face
coverings will be recommended That is especially true because we see spread that is pre-
symptomatic or asymptomatic We expect the universal mask recommendation to continue at
least until an effective vaccine is developed
2 Do you have any guidance for hospitals in making the decision when it is appropriate to relax
visitor restrictions amp stop temperature checks on everyone Am I safe to assume mandatory
mask wear in a hospital setting will continue through this year and into next year
Visitor restrictions are being loosened in some hospitals allowing one visitor per one patient
Nebraska Medicine has not done this yet Decisions on this will depend on which hospital (and
what is going on inside that hospital) plus things like community transmission what region you
are in The issue is that we are seeing community transmission and sometimes transmission is
happening from people who have minimal symptoms they donrsquot feel ill and donrsquot recognize that
they have COVID-19 We are still seeing people identified when they come to our hospitals who
have fevers and donrsquot even realize that when they try to enter I think the temperature checks
will continue for as long as we have universal masking We will probably see loosening of visitor
restrictions as we go forward if the case counts continue to go down Nebraska Medicine has
continued to identity people who have symptoms and temperatures during the screening
process at the entries Another issue Nebraska Medicine has seen in its hospital and clinic
waiting rooms is to be able to adhere to social distancing if you allow each patient to bring along
a visitor With some of the seats marked off to stay empty Nebraska Medicinersquos clinic waiting
rooms are already at capacity just with the patients There are logistical issues when you
increase the number of people coming into the clinics and hospitals That is something you
need to consider in your facilityrsquos planning
3 In regards to eye protection If a person has a prescription safety glasses are those okay for
use Does the eye protection need to be cleaned when going in and out of patient rooms Do
they need to clean after each patient (non-COVID) if glasses didnt visible become soiled
The prescription safety glasses could be allowed if they are OSHA-approved and we knew where
they were acquired For going in and out of patient rooms Nebraska Medicine treats the eye
protection like other extended use PPE The staff member does not touch the eye protection
and if they do then they do remove them and clean them with disinfectant wipes That also
applies if the eye protection becomes visibly soiled they are taken off and disinfected
Otherwise staff is allowed to continue to keep the eye protection on and wear them for an
extended period of time
4 What is the logic for mass testing long-term care staff prior to Phase II What real benefit is a
snap shot in time test result when you are in a situation that staff come and go between
multiple facilities Can go out in the community without restrictions no accountability to
mask andor social distance The reality is you cant control what staff do in the community
We agree that it is important to know that you cannot control what staff does out in the
community but we can educate staff to follow social distancing and masking in the community
Baseline testing does give you an idea what is going on in your facility at the time when you are
considering opening up or relaxing some of the restrictions It gives you a basic idea of your
facility situation If you do a staff testing and that day the entire staff is negative you know your
risk is lower in your facility and you can start reopening with more confidence If you do find a
number of staff positive when you test it is a sign that you may need to wait to relax
restrictions It is also a sign that there could be residents who are COVID-19 positive that you do
not know about who are asymptomatically or pre-symptomatically positive If you were to open
up at that time there may be increased transmission within the home Thatrsquos because when
you go from Phase I to Phase 2 to Phase 3 you would be increasing activities and resident to
resident interaction in the nursing home Staff testing also gives you an idea of what is going on
with the residents because if all the staff are negative chances are that all the residents would
be negative as well The residents are only getting from the staff at this time so if the staff is all
negative it shows they probably are doing the right thing out in the community or that there is
not much COVID-19 in their community right now
5 Since long-term care facilities are being required to test as a baseline will hospital staff also
need to be tested for a baseline
Nursing home residents are a unique population because they are living in a congregate
community Long term care staff are being tested first because it also gives us approximate
measures of what may be going on in the resident population We know that when restrictions
are being lifted the residents will start interacting with each other again and we want to identify
any positive residents before that happens to avoid transmission Those decisions are being
made by the state and we provide guidance but the statersquos decision are ultimately made by
them The hospitals donrsquot have the same situation where patients are interacting with each
other so that risk factor for transmission of COVID-19 isnrsquot present Hospital staff still needs to
be screened and vigilant and everyone has to wear surgical masks for source control and
personal protection But the situations of care are different so that is why long term care staff
is being tested on a baseline and not hospital staff is being tested on a baseline
6 Is all cautery in surgery a risk or just cautery when it involves the nasal or laryngeal areas
Not all cautery in surgery is the same risk Abdominal cautery would not carry the same risk as
nasal or laryngeal cautery which involves the respiratory system Nebraska Medicine follows
this same idea where there isnrsquot risk involved in cautery on legs arms etc
7 Have long-term care facilities been advised by ICAP to not allow admissions into their facilities
until no one (employee or patients) tests positive
The only time that a facility is not going to have admission is if they cannot take care of the
patient they are admitting (the CMS rule refers to not having the capacity the staff expertise or
the PPE to care for patients) A facility that does not have a way to cohort any existing COVID-19
positive patients or have room to take more patients safely is the only time we would tell a
facility not to admit patients There is guidance about admitting a COVID positive patients ndash if
they are within the 28-day time period they should have a two-test negative before they are
admitted especially if they are going into a facility that has not had a COVID-19 case before
because they wonrsquot have a red zone in place If a facility has already had a COVID-19 positive
case and have a red zone in place (separated from the rest of the facility and they have room
there for another positive patient) that is fine There are a lot of case-by-case decisions to be
made
8 Is there anything guidance I could share with staff not to double their maskswearing a N-95
with a surgical mask over top There is concern to conserve their PPE if wearing goggles that
this helps but concern about compromising the fit as well as comfort
This is an issue of how much PPE you have during this time of inventory shortages You still
want PPE worn correctly so the staff can be directed on the correct way You probably need to
talk to the staff to find out reasons for their concern in not following the protocol for wearing
PPE ndash concern over not having enough N95 masks to wear etc Those should be addressed
You can let ICAP know if you are short of PPE so we can try to help with acquisition of PPE
reprocessing etc Keep control over inventory so they arenrsquot taking PPE that they donrsquot need
Someone on your staff can work with others on their PPE use In general we donrsquot recommend
wearing a surgical mask over an N95 A face shield is a different strategy that can be used over
an N95 We still want to limit the use of N95 to one shift per mask Nebraska Medicine has
seen the use migrate to using an N95 mask (down from using face shields extra procedure
masks) etc and they have not seen COVID transmission or increased burn rates for N95 masks
9 For Alisha in OR when wearing goggles over a face shield do you just have reprocess after
that wear
No you just need to wipe them with disinfectant wipes once you take them off They are not
reprocessed
multiple facilities Can go out in the community without restrictions no accountability to
mask andor social distance The reality is you cant control what staff do in the community
We agree that it is important to know that you cannot control what staff does out in the
community but we can educate staff to follow social distancing and masking in the community
Baseline testing does give you an idea what is going on in your facility at the time when you are
considering opening up or relaxing some of the restrictions It gives you a basic idea of your
facility situation If you do a staff testing and that day the entire staff is negative you know your
risk is lower in your facility and you can start reopening with more confidence If you do find a
number of staff positive when you test it is a sign that you may need to wait to relax
restrictions It is also a sign that there could be residents who are COVID-19 positive that you do
not know about who are asymptomatically or pre-symptomatically positive If you were to open
up at that time there may be increased transmission within the home Thatrsquos because when
you go from Phase I to Phase 2 to Phase 3 you would be increasing activities and resident to
resident interaction in the nursing home Staff testing also gives you an idea of what is going on
with the residents because if all the staff are negative chances are that all the residents would
be negative as well The residents are only getting from the staff at this time so if the staff is all
negative it shows they probably are doing the right thing out in the community or that there is
not much COVID-19 in their community right now
5 Since long-term care facilities are being required to test as a baseline will hospital staff also
need to be tested for a baseline
Nursing home residents are a unique population because they are living in a congregate
community Long term care staff are being tested first because it also gives us approximate
measures of what may be going on in the resident population We know that when restrictions
are being lifted the residents will start interacting with each other again and we want to identify
any positive residents before that happens to avoid transmission Those decisions are being
made by the state and we provide guidance but the statersquos decision are ultimately made by
them The hospitals donrsquot have the same situation where patients are interacting with each
other so that risk factor for transmission of COVID-19 isnrsquot present Hospital staff still needs to
be screened and vigilant and everyone has to wear surgical masks for source control and
personal protection But the situations of care are different so that is why long term care staff
is being tested on a baseline and not hospital staff is being tested on a baseline
6 Is all cautery in surgery a risk or just cautery when it involves the nasal or laryngeal areas
Not all cautery in surgery is the same risk Abdominal cautery would not carry the same risk as
nasal or laryngeal cautery which involves the respiratory system Nebraska Medicine follows
this same idea where there isnrsquot risk involved in cautery on legs arms etc
7 Have long-term care facilities been advised by ICAP to not allow admissions into their facilities
until no one (employee or patients) tests positive
The only time that a facility is not going to have admission is if they cannot take care of the
patient they are admitting (the CMS rule refers to not having the capacity the staff expertise or
the PPE to care for patients) A facility that does not have a way to cohort any existing COVID-19
positive patients or have room to take more patients safely is the only time we would tell a
facility not to admit patients There is guidance about admitting a COVID positive patients ndash if
they are within the 28-day time period they should have a two-test negative before they are
admitted especially if they are going into a facility that has not had a COVID-19 case before
because they wonrsquot have a red zone in place If a facility has already had a COVID-19 positive
case and have a red zone in place (separated from the rest of the facility and they have room
there for another positive patient) that is fine There are a lot of case-by-case decisions to be
made
8 Is there anything guidance I could share with staff not to double their maskswearing a N-95
with a surgical mask over top There is concern to conserve their PPE if wearing goggles that
this helps but concern about compromising the fit as well as comfort
This is an issue of how much PPE you have during this time of inventory shortages You still
want PPE worn correctly so the staff can be directed on the correct way You probably need to
talk to the staff to find out reasons for their concern in not following the protocol for wearing
PPE ndash concern over not having enough N95 masks to wear etc Those should be addressed
You can let ICAP know if you are short of PPE so we can try to help with acquisition of PPE
reprocessing etc Keep control over inventory so they arenrsquot taking PPE that they donrsquot need
Someone on your staff can work with others on their PPE use In general we donrsquot recommend
wearing a surgical mask over an N95 A face shield is a different strategy that can be used over
an N95 We still want to limit the use of N95 to one shift per mask Nebraska Medicine has
seen the use migrate to using an N95 mask (down from using face shields extra procedure
masks) etc and they have not seen COVID transmission or increased burn rates for N95 masks
9 For Alisha in OR when wearing goggles over a face shield do you just have reprocess after
that wear
No you just need to wipe them with disinfectant wipes once you take them off They are not
reprocessed
facility not to admit patients There is guidance about admitting a COVID positive patients ndash if
they are within the 28-day time period they should have a two-test negative before they are
admitted especially if they are going into a facility that has not had a COVID-19 case before
because they wonrsquot have a red zone in place If a facility has already had a COVID-19 positive
case and have a red zone in place (separated from the rest of the facility and they have room
there for another positive patient) that is fine There are a lot of case-by-case decisions to be
made
8 Is there anything guidance I could share with staff not to double their maskswearing a N-95
with a surgical mask over top There is concern to conserve their PPE if wearing goggles that
this helps but concern about compromising the fit as well as comfort
This is an issue of how much PPE you have during this time of inventory shortages You still
want PPE worn correctly so the staff can be directed on the correct way You probably need to
talk to the staff to find out reasons for their concern in not following the protocol for wearing
PPE ndash concern over not having enough N95 masks to wear etc Those should be addressed
You can let ICAP know if you are short of PPE so we can try to help with acquisition of PPE
reprocessing etc Keep control over inventory so they arenrsquot taking PPE that they donrsquot need
Someone on your staff can work with others on their PPE use In general we donrsquot recommend
wearing a surgical mask over an N95 A face shield is a different strategy that can be used over
an N95 We still want to limit the use of N95 to one shift per mask Nebraska Medicine has
seen the use migrate to using an N95 mask (down from using face shields extra procedure
masks) etc and they have not seen COVID transmission or increased burn rates for N95 masks
9 For Alisha in OR when wearing goggles over a face shield do you just have reprocess after
that wear
No you just need to wipe them with disinfectant wipes once you take them off They are not
reprocessed